[Cardioembolic stroke due to mitral annular calcification with a mobile component]

Area of Science:

• Cardiology
• Neurology
• Nephrology

Background:

• Maintenance hemodialysis is a life-sustaining treatment for end-stage renal disease.
• Cerebrovascular events, such as stroke, are a significant complication in patients undergoing hemodialysis.
• Mitral annular calcification (MAC) is a common finding in the elderly and in patients with chronic kidney disease.

Observation:

• A 50-year-old male on maintenance hemodialysis presented with acute right hemiparesis and aphasia.
• Neuroimaging revealed an ischemic stroke in the territory of the left middle cerebral artery.
• Echocardiography identified mitral annular calcification (MAC) with a mobile, calcified component attached to the posterior mitral valve.

Findings:

• The patient was diagnosed with a cardioembolic stroke.
• The stroke was attributed to a mobile component of mitral annular calcification (MAC).
• Heparin treatment led to a partial reduction in the size of the mobile MAC component, but it persisted.

Implications:

• This case highlights MAC with a mobile component as a potential source of cardioembolic stroke, even in patients on hemodialysis.
• It underscores the importance of thorough cardiac evaluation, including echocardiography, in hemodialysis patients presenting with stroke.
• Further research may be warranted to explore optimal anticoagulation strategies for MAC-related cardioembolic events in this population.