Calcified cerebral emboli: numerous particles on computed tomography

Excerpt

An 80-year-old woman with a previous history of dementia was found slumped and brought to our hospital. On examination, she had total aphasia, leftward gaze deviation, and right hemiplegia. Brain computed tomography (CT) and magnetic resonance imaging were immediately performed for suspected acute stroke. Brain CT revealed edematous low-density lesions in the left anterior and middle cerebral artery (MCA) region (Fig. 1a–d) with 16 calcified particles in the same region (arrows, Figs. 1a, b, 2a, b). On diffusion-weighted magnetic resonance imaging (DWI), the edematous lesions were of high intensity with additional signal abnormalities in the pons, cerebellum, and right cerebral hemisphere (Fig. 2c). The particles were not apparent on DWI and fluid-attenuated inversion recovery imaging. Furthermore, ultrasound echocardiography detected calcified aortic valves without atrial fibrillation on electrocardiogram. CT angiography revealed vascular calcifications in the brachiocephalic artery, bilateral internal carotid arteries, and descending aorta, but not in the ascending aorta. The patient was diagnosed with cerebral infarction due to calcified cerebral emboli (CCE), which were suspected to be derived from the calcified aortic valves because of the wide range of infarctions. She was treated with intravenous edaravone and glycerol, but severe neurological deficits remained. One month after the symptom onset, follow-up CT showed atrophic low-density lesions in the left MCA region (Fig. 3a–d) with 11 high-density particles, five of which were located nearly at the same locations as the particles on the initial CT (arrows, Fig. 3b–d).

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