Fellows’ Journal Club
August 2014
(2 of 3)
The prevalence, imaging appearance, presumed source, treatment, and outcome of patients with calcified cerebral emboli on CT were assessed in 22 cases seen by the authors and in 48 from the literature. Most calcified emboli were found in the middle cerebral artery territory and were thought to arise from the heart, aortic arch, or carotid plaques. The overall prevalence of these emboli was 2.7% with 27% initially misdiagnosed and 9% overlooked on the first interpretation.
Abstract
BACKGROUND AND PURPOSE
Calcified cerebral emboli are a rarely reported but devastating cause of stroke and may be the first manifestation of vascular or cardiac disease. Our aim was to evaluate the diagnosis, prevalence, imaging appearance, presumed embolic source, treatment, and outcome of patients with calcified cerebral emboli.
MATERIALS AND METHODS
Our radiology information system was searched for all CT scans by using keywords “calcified,” “emboli,” and their permutations. The radiology information system was also searched to identify all “stroke” CT reports to calculate the prevalence of calcified cerebral emboli. We also performed a MEDLINE search to identify all published case reports.
RESULTS
Twenty-two cases were identified from our database, and 48 were cases reported from the literature. The middle cerebral artery was the site of 83% of calcified emboli. Presumed sources were calcific aortic stenosis (36%), carotid atherosclerotic plaque (30%), and mitral annular calcification (11%). Spontaneous embolism occurred in 86%. Surgical treatment was performed in 34% of patients. Sixty-four percent of the patients with calcified aortic stenosis underwent aortic valve replacement. Among those with identifiable arterial disease, 53% underwent endarterectomy. Forty-one percent of patients experienced at least 1 recurrent stroke. The prevalence of calcified cerebral emboli identified on stroke CT scans at our institution was 2.7%. Seventy-three percent of cases were correctly identified. Twenty-seven percent were misdiagnosed on initial interpretation, while 9% were overlooked on preliminary interpretation.
CONCLUSIONS
Calcified cerebral emboli are more common than previously assumed, are frequently overlooked or misinterpreted, affect clinical course when diagnosed, and carry substantial risk for recurrent stroke.
