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Spontaneous calcific embolization to the supraclinoid internal carotid artery from a regurgitant bicuspid aortic
M E O'Donoghue1, F Dangond, A J Burger
1Harvard Longwood Neurology Program, New England Deaconess Hospital, Boston, MA.
Insights
Rarely recognized calcific brain embolization can cause stroke. This case highlights emboli from a calcified bicuspid aortic valve causing right cerebral circulation stroke, diagnosed via CT imaging.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Bicuspid aortic valves are common congenital heart defects.
- These valves are prone to stenosis, regurgitation, calcification, and infection.
- Calcific embolization leading to stroke is an underrecognized complication.
Observation:
- A patient presented with spontaneous embolization to the right cerebral circulation.
- The source was identified as a severely regurgitant, calcified bicuspid aortic valve.
- The calcific embolus dislodged from a noninfected valve without acute rupture.
Findings:
- Spiral CT imaging accurately localized the calcific embolus.
- The embolus was found in the right supraclinoid internal carotid artery.
- This demonstrates a rare cause of ischemic stroke.
Implications:
- Highlights a rare cause of stroke: calcific emboli from bicuspid aortic valves.
- Emphasizes the need for considering cardiac sources in cryptogenic strokes.
- Suggests spiral CT is valuable for identifying calcific emboli in cerebral circulation.
Abstract:
Calcific brain embolization leading to stroke is rarely recognized. We report a case of spontaneous embolization to the right cerebral circulation from a severely regurgitant, calcified bicuspid valve. Bicuspid aortic valves constitute the most common congenital heart abnormality, and have a tendency to become stenosed, regurgitant, calcified, or infected. The presence of heavy calcification in a noninfected bicuspid valve may lead to dislodgement of calcific embolic material which is not necessarily heralded by acute valvular rupture. Accurate localization of the calcific embolus to the right supraclinoid internal carotid artery was provided by spiral CT imaging in this case.