Calcified cerebral emboli from left ventricular thrombus

Case contributed by Dr Tom Foster

Presentation

Change in personality, falls, agitation and behaving out of character.

Patient Data

Age: 85 years
Gender: Female

Previous left PCA territory infarct.

Multiple tiny calcific foci peripherally throughout the brain (more easily visible on the MIP images).

Small calcified left parafalcine meningioma posteriorly. 

Small rounded peripherally calcified structure closely related to the anterior aspect of the ICA, probably represents small calcified aneurysm.

Single lead ventricular cardiac permanent pacemaker in situ. Metal mitral valve replacement (Bjork Shiley valve).

Mild cardiomegaly. Calcification projected over the left side of the heart.

No collapse or consolidation.

Within the left ventricle is a large region of calcification, probably representing calcified thrombus, extending from around the level of the mitral valve to the left ventricular apex. There is a small incidental left ventricular apex aneurysm.

Case Discussion

Calcified cerebral emboli are a rare cause of embolic ischemic stroke.

This patient has had a previous left PCA territory infarct, it is not clear whether this is directly related to the calcified emboli or not.

When calcified cerebral emboli are seen, it is often in the territory of a single cerebral artery. In this case they are throughout the entire brain. This implies a very central source of the emboli.

Review of previous chest imaging demonstrated a large calcification within the left ventricle, probably representing calcified thrombus. Patient had a background of previous MI approximately 40 years previously (note the additional finding of a left ventricular aneurysm).

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