Large highly mobile complex ascending aortic atheroma causing left middle cerebral artery stroke in patient without any history of cardiac disease.

Introduction: A complex atheroma of the aortic arch puts a patient at risk for an embolic stroke. We present a patient with no cardiac history who came with acute stroke-like symptoms from a large, complex aortic atheroma. Case presentation: A 60-yearold woman with known thoracic aortic aneurysm presented with acute right-sided weakness. An MRI of the brain showed a left middle cerebral artery (MCA) embolic stroke. A CT angiogram (CTA) showed the known, stable thoracic aneurysm and concern for type A aortic dissection. Later gated CT scan revealed a focal filling defect in the proximal aortic arch, compatible with a floating thrombus. A transesophageal echocardiogram (TEE) then demonstrated a 18mm by 14mm, highly mobile atheroma in this area. Specialty team concluded that the stroke was due to the atheroma and suggested anticoagulation and statin therapy. Discussion: A large and mobile aortic atheromas are recognized as a potential cause of embolic events in the elderly population. These patients will benefit from an anticoagulation and statin therapy to reduce the risk of stroke recurrence. Conclusion: A complex aortic atheroma is likely an independent risk factor for embolic stroke and may be an indication for prophylactic anticoagulation and statin therapy.