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Ischemic Stroke and Mitral Annular Caseous Calcification: A Neglected Embolic Risk in Cardio-Neurological Interface?

Ezgi Yilmaz1, Selin A Duzgun2, Ethem M Arsava1

  • 1Departments of Neurology.

The Neurologist
|March 30, 2026
PubMed

Insights

Caseous mitral annulus calcification (MAC) is more prevalent in stroke patients. This condition significantly increases stroke risk, suggesting it may be a cause of embolic stroke.

Area of Science:

  • Cardiology
  • Neurology
  • Radiology

Background:

  • Caseous mitral annulus calcification (MAC) is linked to stroke and embolism.
  • Cardiac CT is used to detect caseous MAC.

Purpose of the Study:

  • Assess caseous MAC prevalence in acute stroke patients using cardiac CT.
  • Identify factors associated with caseous MAC occurrence.

Main Methods:

  • Retrospective case-control study.
  • Included 149 acute ischemic stroke patients with cardiac CT, 300 without cardiac CT, and 268 controls.
  • Propensity matching and regression models were used.

Main Results:

  • Caseous MAC detected in 5.4% of stroke patients vs. 1.1% in controls (P=0.02).
  • Caseous MAC independently increased stroke risk 7.57- to 10.81-fold (P=0.011).

Conclusions:

  • Caseous mitral annulus calcific granuloma may cause embolic stroke.
  • Further multicenter studies are needed for validation.
Abstract

Keywords:
calcified granulomacryptogenicischemic strokeliquefactive necrosismitral valve functiontumor

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