on March 12, 2009
Published online before print March 12, 2009, doi: 10.1161/STROKEAHA.108.538009
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Submitted on October 2, 2008
From the University of Tennessee Medical Center, Knoxville, Tenn. * To whom correspondence should be addressed. E-mail: b_rett{at}yahoo.com.
Background and Purpose—Unenhanced head CT has become the first line imaging study in the evaluation of suspected acute cerebral ischemia. It is important to identify subtle findings of acute ischemia on this exam to direct appropriate patient management. Summary of Case—We report the first case of multiple pial surface distal internal carotid artery territory calcified emboli causing multifocal cerebral infarctions, likely from a carotid bifurcation source. Conclusions—Visualization of multiple pial surface calcifications on unenhanced head CT, the ‘salted pretzel sign’, should raise suspicion for acute infarction from showered calcific emboli.
Revised on November 3, 2008
Accepted on November 7, 2008
Showered Calcific Emboli to the Brain, the ‘Salted Pretzel’ Sign, Originating From the Ipsilateral Internal Carotid Artery Causing Acute Cerebral Infarction
Brett A. Christian MD*;
Key words: acute care • brain infarction • cerebrovascular accident • CT • MRI • radiology • stroke in evolution