Embolic stroke diagnosed by elevated d-dimer in a patient with negative TEE for cardioembolic source

Irina Y. Sazonova, Roja Pondicherry-Harish, Nikhil Kadle, Gyanendra K. Sharma, Ramon E. Figueroa, Vincent J.B. Robinson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


We report a case of cerebrovascular accident with thromboembolic stroke etiology in a patient who had atrial flutter and negative transesophageal echocardiography (TEE) results. The increased D-dimer levels (1877 ng/mL) initiated referral for magnetic resonance imaging and magnetic resonance angiography of the brain that showed classic recanalization of an embolic thrombus in the angular branch of the left middle cerebral distribution. The D-dimer level of this patient was normalized after 3 months of anticoagulation therapy. Although TEE is considered the gold standard for evaluation of cardiac source of embolism, exclusion of intracardiac thrombus with TEE alone does not eliminate the risk of thromboembolic events. This case highlights the utility of D-dimer as a potential adjunct in the decision-making process to guide investigation of thromboembolism, determine subsequent therapy, and hence reduce the risk of embolic stroke recurrence.

Original languageEnglish (US)
JournalJournal of Investigative Medicine High Impact Case Reports
Issue number4
StatePublished - Nov 14 2014


  • Atrial thrombosis
  • D-dimer
  • Stroke
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Epidemiology
  • Safety, Risk, Reliability and Quality
  • Safety Research


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