Cerebral cholesterol embolism: A report of two cases after postmortem examination

Systemic cholesterol embolism, either spontaneous or due to intravascular procedures or to anticoagulant/trombolytic therapy, is a rare disease, occasionally involving the Central Nervous System. We report the cases of two males (respectively 68 and 71 years old) in whom, after postmortem examination, a systemic cholesterol embolism, involving the brain, was found. The two patients were affected by increased blood pressure, aortic aneurysm and underwent intravascular procedures. The former patient lost somatosensory cortical evoked responses over the left cerebral hemisphere during reparative surgery, as soon as the surgeon removed the proximal aortic clamp. The patient showed postoperative right hemiplegia and seizures, that lasted until he died. Istopathologic examination performed after autopsy revealed focal brain infarction due to cholesterol embolism. The latter patient, after aortography, showed clinical symptoms of renal infarction and failure, duodenal ulcer and ischaemic disease affecting the lower limbs. After autopsy systemic cholesterol embolism, also involving meningeal vessels, and infarction of the right thalamus were found. Cholesterol embolism should always be kept in mind in the differential diagnosis of the ischaemic brain disturbances, mostly in patients with atherosclerotic involvement of the aortic/carotid arteries and undergoing intravascular/surgical procedures.