Ruptured mitral chordae and widespread calcified intracranial emboli: An unusual presentation of native valve...

Calcified cerebral embolism (CCE) is an uncommonly diagnosed, potentially fatal cause of acute ischemic stroke. In many instances, its detection may be missed completely. Knowledge of CCE is crucial as it is associated with high recurrence rate and worse clinical outcome.

A 67-year-old woman with multiple comorbidities and vascular risk factors presented with acute neurologic symptoms. Computed Tomography (CT) stroke protocol imaging revealed multiple cerebral infarcts with numerous calcified intracranial emboli, suggesting a cardiac source. Echocardiography demonstrated a large mitral valve vegetation with ruptured chordae and severe mitral regurgitation, consistent with native valve infective endocarditis. Despite medical and surgical management, her course was complicated by recurrent ischemic strokes and death.

We present an unprecedented case of CCE following spontaneous mitral valve rupture showing the "Stardust" sign on CT head. To our knowledge, this novel cause of CCE and radiological finding have not been previously reported, which is of diagnostic value. This case report highlights a novel pathophysiological mechanism of CCE.