The thrombus of the aortic arch: a rare pathology in intensive care unit.

A 54-year-old patient was admitted to the intensive care unit for voluntary drug intoxication with zolipidem (Stilnox(R)), dimenhydrinate (Mercalm(R)) , and oestradiol 17 beta (Oromone(R)). Four hours after the admission the p atient was comatose. Cerebral computerized tomodensitometry demonstrated mu ltiple zones of ischaemia. Transoesophageal echocardiography was performed 12 hours after the arrival of the patient and revealed a mobile thrombus of the aortic arch. The remainder of the visualized aortic arch did not prese nt atherosclerotic plaque. Secondarily, ischaemia of the right superior lim b was diagnosed probably cause by emboli originating in the aortic thrombus appeared. The patient died three days later after her arrival, because of neurologic sequelae of the cerebral embolic events. This clinical case unde rlines the concept that the diagnosis of drug intoxication must remain a di agnosis of elimination. The thrombosis of the aortic arch is a rare patholo gy in intensive care units. In the presence of unexplained ischaemic stroke and an peripheral emboli, the thrombosis of the aortic arch should be susp ected. (C) 2000 Editions scientifiques et medicales Elsevier SAS.