A 41-year-old male patient with a history of hypercholesterolemia, stroke, and congestive heart failure that required an implantable cardioverter defibrillator presented 45 minutes from stroke symptom onset. His medical history was also significant for myocardial infarction that required 2-vessel percutaneous transluminal coronary angioplasty and stenting with triple coronary bypass surgery complicated by acute intraoperative rethrombosis.
Physical examination revealed a decreased level of consciousness, right hemiplegia, aphasia, and a National Institutes of Health Stroke Scale score of 16. Computed tomography results at 1 hour postictus were normal.
A 41-year-old male patient with a history of hypercholesterolemia, ischemic stroke, and acute myocardial infarction. He presented with a score of 16 on the National Institutes of Heath Stroke Scale 45 minutes from symptom onset. A, Pretreatment injection of angiographic contrast into the left inferior cerebral artery revealed an occlusion of the middle cerebral artery M1 region (arrow). B, Successful recanalization with the Penumbra System (Penumbra Inc, Alameda, California) in the M1 and the inferior division of the left middle cerebral artery with persistent occlusion of the superior division (arrow). C, Gross specimen view demonstrated soft, brown, spongelike emboli (scale is in millimeters). D, Histopathologic examination revealed fresh fat emboli with abundant round empty voids from the dissolved fat surrounded by fibrin, leukocytes, and thrombocytes. There was no evidence of fat cells or cholesterol clefts (hematoxylin-eosin, original magnification ×200).
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