This Article Full Text Full Text (PDF) All Versions of this Article: 37/1/e6    most recent 01.STR.0000195211.76192.edv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Moustafa, R. R. Articles by Baron, J.-C. Search for Related Content PubMed PubMed Citation Articles by Moustafa, R. R. Articles by Baron, J.-C. Related Collections CT and MRI Acute Cerebral Infarction Embolic stroke

(Stroke. 2006;37:e6.)
© 2006 American Heart Association, Inc.

Case Reports

Stroke Attributable to a Calcific Embolus From the Brachiocephalic Trunk

From the Department of Clinical Neurosciences and Stroke Unit (R.R.M., E.A.W., J.C.B.), University of Cambridge, Cambridge, UK; and the University Department of Radiology (N.M.A., R.A.C.), Addenbrooke’s Hospital, Cambridge, UK.

Correspondence to Jean-Claude Baron, MD, Department of Neurology, Box 83, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK. E-mail jcb54{at}cam.ac.uk

Abstract

Background and Purpose— Calcific brain embolization is a rare event that is usually secondary to cardiac valve calcification. We present a case of stroke caused by embolization of calcific material from the brachiocephalic trunk, probably induced by radiotherapy.

Summary of Case— A 56-year-old right-handed female developed left-sided hemiparesis, hemihypesthesia, and sensory inattention. She had a history of right breast carcinoma that was excised 8 years previously followed by radiotherapy. She had no other history of note. Computed tomography of the head and magnetic resonance imaging confirmed a calcific embolus in right middle cerebral artery and an acute infarction in the corresponding territory. Plain chest radiography, carotid ultrasonography, transthoracic and transoesophageal echocardiography failed to demonstrate the source of calcific embolism. Computed tomography of the thorax revealed heavy calcification of the brachiocephalic trunk and the origin of the right common carotid artery.

Conclusions— Undertaking a vigilant systematic search for the source in cases of calcific embolization is necessary. The aorta and its main branches are possible, yet unusual, sources of calcific emboli that merit investigation.

Key Words: brachiocephalic trunk • calcinosis • carotid arteries • embolism • radiotherapy • stroke