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Calcified cerebral infarcts due to calcified aortic valve disease or to cardiac catheterisation have previously been reported.1–3 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.
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.
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