Presentation
Confusion. Acute right sided weakness.
Patient Data
Hypoattenuation of the anterior half of the left insular cortex with subtle early loss of grey-white matter differentiation of the left frontal and parietal lobes and slight swelling gyri in keeping with ischemia. No acute intracranial hemorrhage.
Large calcific focus at the left MCA bifurcation. Multiple small calcific foci within the distal left MCA branches (M3, M4). Moderate to severe microangiopathic changes bilaterally. Ventricles and CSF cisterns are preserved in age-appropriate. No midline shift or tonsillar herniation.
Case Discussion
Example of the salted pretzel sign, due to embolic showering of small calcific emboli in the left MCA vascular territory.
The patient was treated with IV thrombolysis.