Article Text

Download PDFPDF

Stroke with calcium emboli related to a calcified stenosis of internal carotid artery
  1. J Tardy1,
  2. N Da Silva2,
  3. Y Glock3,
  4. V Larrue1
  1. 1
    Department of Vascular Neurology, Rangueil University Hospital, Toulouse, France
  2. 2
    Department of Neuroradiology, Rangueil University Hospital, Toulouse, France
  3. 3
    Department of Vascular Surgery, Rangueil University Hospital, Toulouse, France
  1. Jean Tardy, Service de Neurologie Vasculaire, Hôpital de Rangueil, TSA 50032, 31059 Toulouse cedex 9, France; tardyjean{at}yahoo.fr

Statistics from Altmetric.com

Calcified cerebral infarcts due to calcified aortic valve disease or to cardiac catheterisation have previously been reported.13 In contrast, descriptions of such emboli from calcified atherosclerotic plaques in the carotid artery are rare. We report the case of a 61-year-old man with stroke and calcium emboli related to a calcified stenosis of internal carotid artery.

The patient was admitted to the department of vascular neurology of our institution with left hemiparesia related to an ischaemic stroke. An initial CT scan showed several spontaneous calcific attenuations in the middle cerebral artery territory (fig 1A, B, C). These hyperdensities were not present on a CT scan that was performed 1 year previously. A CT scan performed 12 hours after admission confirmed that the hyperdensities were located on the spot of the cerebral infarct (fig 2A, B, C). Duplex-Doppler colour-coded ultrasonography (fig 3) and CT-scan angiography (fig 4) revealed a calcified atherosclerotic plaque located on the origin of the right internal carotid artery, with an endoluminal calcified floating segment. Transcranial Doppler (TCD) monitoring of the right middle cerebal artery recorded one micro-embolic signal. Right carotid endarterectomy showed a highly calcified atherosclerotic plaque (fig 5) and confirmed that calcified emboli from the internal carotid artery was the most probable aetiology of this stroke.

Figure 1 Initial head CT scan showing cortical calcified emboli in the right frontal and parietal lobes with minimal early signs of ischaemic infarction in the parietal lobe with lack of interface between grey and white matter (A, B, C; arrow).
Figure 2 Head CT scan performed 12 hours after disclosing more evident signs of cerebral infarction due to calcified emboli (A, B, C).
Figure 3 Duplex-Doppler colour-coded ultrasonography showing a calcified atherosclerotic plaque located on the origin of the internal carotid artery, with an endoluminal calcified floating segment (arrow).
Figure 4 Multidetector CT angiography of the neck vessels disclosing an eccentric and stenosing calcified plaque involving right carotid bifurcation and carotid bulb. There are calcified plaques with a lesser degree of stenosis located in the left internal carotid and vertebral arteries.
Figure 5 Highly calcified plaque resected by open endarterectomy.

Cases of calcified cerebral emboli have recently been reported, but have usually been secondary to aortic valve disease or cardiac catheterisation.4

To our knowledge, this is the first description of spontaneous calcified emboli from the carotid artery, without previous manipulation.5 The presence of a micro-embolic signal on TCD indicates the high risk of recurrence of such calcified atherosclerotic plaques in the absence of surgery.

REFERENCES

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.