E4960. Unusual Suspects: A Case Review of Nonatherothrombotic, Noncardioembolic Cerebral Embolism
  1. Harvey Sekhon; University of Nebraska Medical Center
  2. Grant Zomermaand; University of Nebraska Medical Center
  3. Sean Kelly; University of Nebraska Medical Center
  4. Mark Keiper; University of Nebraska Medical Center
Radiologists play a crucial role in the diagnosis of acute stroke and are often the first provider to identify a specific etiology. Most cerebral emboli are of cardioembolic and atherothrombotic origin. Nonatherothrombotic, noncardioembolic cases of embolic stroke are rare but important for the radiologist to be familiar with because management will vary considerably from standard thrombolysis and thrombectomy. Although a relatively rare phenomenon, high clinical suspicion and early treatment is often required to reduce morbidity and mortality associated with these unusual cases.

Educational Goals / Teaching Points
The goals of our presentation are to discuss and illustrate nonatherothrombotic and noncardioembolic causes of cerebral embolism, including entities such as cerebral air, fat, septic, and iatrogenic emboli in a case-based review from our large academic institution. In addition to the cases provided, the exhibit will include other common clinical presentations and risk factors associated with specific nonatheroembolic cerebral embolism. Finally, and most importantly, it will emphasize radiological features and discuss diagnostic limitations using various imaging modalities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The cases will be organized to include a brief clinical history, imaging indication, annotated images, clues to accurately interpret the case, and suggestions for additional workup when applicable. Our series of cases will highlight different forms of cerebral embolic disease. Some of the cases to be presented include an unusual case of cerebral air embolism in a patient discovered to have a spontaneous pneumothorax in the setting of interstitial lung disease, waxing and waning air emboli in a patient with a suspected left ventricular assist device infection, fat emboli in the traumatic setting, septic emboli, and inadvertent iatrogenic cerebral embolization.

This educational exhibit will provide a solid fund of cases to expand the viewer’s understanding of this relatively rare entity. We hope to improve the interpreting radiologist’s ability to quickly identify the source of embolic stroke while emphasizing timely and effective management to improve patient outcomes.