The patient underwent right carotid endarterectomy. NCCT ( D) with initial scan (left) and follow-up scan (right) 1 day later shows interval migration of calcified embolus ( arrows) within the right MCA.
Coronal MIP image ( C) shows the calcific distal common proximal internal carotid artery plaque ( arrow), which was identified as the probable source of emboli. The new ischemic injury ( curved arrow, right) is shown just posterior to the old infarction. CT perfusion ( B) shows the old infarction ( white arrows) as a focal area of decreased cerebral blood volume (left). Subtle hypoattenuation of the adjacent gyrus is also present ( black arrow). The noncontrast CT scan ( A) shows calcified emboli ( straight arrows) in the horizontal MCA segment and posterior division of the MCA with adjacent encephalomalacia ( curved arrows). An 84-year-old man with a known remote right MCA infarct had sudden onset of new strokelike symptoms. We demonstrate that these emboli are more common than previously assumed, are frequently overlooked, and carry substantial risk for recurrent stroke.Ĭase 1.
#Divisions of pica artery series#
We report the first comprehensive review of the literature and present the largest imaging series to date, to our knowledge. The purpose of this study was to evaluate the diagnosis, prevalence, imaging appearance, presumed embolic source, treatment, and outcome of patients with calcified cerebral emboli. 1 Since then, there have been only 48 cases reported in the literature. The first imaging report of calcified cerebral emboli was published in 1981.
Noncontrast CT of the head is the most common imaging procedure used as the initial assessment of suspected stroke. Proper identification can guide treatment toward preventing future embolic events, neurologic impairment, and death. Calcified cerebral emboli are a rarely reported but potentially devastating cause of stroke and may be the first manifestation of vascular or cardiac disease.
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