Calcified cerebral embolism: a 9-case series and review of the literature
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Published on: September 25, 2016
A J Mosqueira1, B Canneti2, A Martínez Calvo3
1Servicio de Radiodiagnóstico, Hospital Universitario Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
Insights
Calcified cerebral embolus (CCE) is an underdiagnosed stroke cause. This study found CCE more frequent than expected, originating from cardiac or carotid sources, with poor prognosis in most cases.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Calcified cerebral embolus (CCE) is a rare cause of stroke.
- CCE can be the initial sign of underlying vascular or cardiac conditions.
Purpose of the Study:
- To describe the characteristics of CCE in a series of 9 patients.
- To review the literature on CCE as a cause of stroke.
Main Methods:
- Retrospective analysis of 9 patients with CCE from three hospitals.
- Evaluation of diagnostic approach, neuroimaging, embolism origin, treatment, and prognosis.
Main Results:
- All 9 patients experienced acute ischemic stroke due to CCE, affecting the middle cerebral artery.
- Calcific sources identified in 66.6% of cases (33.3% carotid, 33.3% cardiac).
- Limited acute treatment (1 patient) and poor functional outcomes (11% mRS ≤ 2 at 3 months).
Conclusions:
- CCE is more common than previously recognized.
- Despite being underdiagnosed, CCE has significant prognostic implications in stroke etiology.
- Further research is needed to improve diagnosis and management of CCE.
Objective:
Calcified cerebral embolus (CCE), a rarely reported and underdiagnosed cause of stroke, may be the first manifestation of a vascular or cardiac disease. We describe the characteristics of CCE in a series of 9 cases and review the literature on the subject.
Patients And Methods:
We included patients with CCE from 3 different hospitals. We describe the diagnostic approach, neuroimaging findings, origin of the embolism, treatment, and prognosis of these patients.
Results:
We identified a total of 9 patients presenting spontaneous CCE as the cause of acute ischaemic stroke. In all cases, the middle cerebral artery was affected; all patients underwent CT. A possible calcific source was found in 6 patients (66.6%), originating in the carotid arteries in 3 (33.3%) and in the heart in the other 3 patients (33.3%). Only one patient was treated in the acute phase (trombectomy) and only 11% of patients had modified Ranking Scale scores ≤ 2 at 3 months.
Conclusions:
CCE is more frequent than previously thought and, although the condition continues to be underdiagnosed, it is of considerable prognostic relevance in the aetiological study of stroke.
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