Transient ischemic attack due to multiple spontaneous calcified embolus of the cerebral arteries on a calcified mitral and aortic stenosis

Taoussi, Réda; Khattab, Hajar; Jadib, A.; Daki, Anouar; Bendahou, Hajar; Sabiri, Mouna; Manjra, Samia El; Lezar, S.; Essodegui, Fatiha

doi:10.1016/j.radcr.2022.05.043

Cited by 2 publications

(3 citation statements)

References 9 publications

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“…Cerebral vessel calcifications are more commonly tubular/linear in shape, contrasting the round/ovoid appearance of CCE ( 8 ). Other CCE mimics to rule out include hyperdense artery sign, small haemorrhage, sequelae from past infections, normal calcified structures such as the choroid plexus, calcified granulomas or cavernomas and neurocysticercosis ( 10 ). The MCA has consistently been demonstrated to be the most common location of CCE and localisation may be another assisting factor in supporting CCE diagnosis ( 2 , 5–7 ).…”

Section: Discussionmentioning

confidence: 99%

“…Other components of the Supportive criteria are clinical/radiological features which favour the diagnosis of CCE, such as previous CCE, localisation to the MCA and presence of chronic kidney disease (CKD). Comorbidities such as CKD are associated with development of valvular/vascular calcification ( 29 ), and several reports have demonstrated the presence of CCE in CKD patients ( 10 , 30–33 ).…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous calcified cerebral emboli: a comprehensive review and proposed diagnostic criteria

Menounos,

Matar

2024

Front. Neurol.

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Spontaneous calcified cerebral emboli (SCCE) secondary to aortic valve calcification are a rare and underreported cause of acute ischaemic stroke. Only five cases of SCCE secondary to bicuspid aortic valve calcification have been reported in the literature. This review includes a unique case example of acute ischaemic stroke secondary to SCCE, as the first manifestation of a calcified bicuspid aortic valve. This is the first clinical case of calcified cerebral emboli (CCE) associated with borderzone infarction (‘cortical ribbon sign’). Whilst previously assumed that most CCE are secondary to iatrogenic causes, recent literature suggests the majority of CCE are spontaneous and clinically silent. Despite CT imaging widely considered the ‘gold standard’ for diagnosis, CCE are frequently misdiagnosed and missed entirely. Misdiagnosis of CCE may have catastrophic consequences due to the high risk of recurrence and missed opportunity to prevent neurological disability and death. This review presents a revised CCE diagnostic criteria, using evidence that has emerged over the last decade to create both Compulsory (Major) and Supporting (Minor) criteria. Current CCE management is not evidence based and remains largely speculative. SCCE may be the first manifestation of cardiac or vascular disease and diagnosis should trigger aggressive treatment of emboligenic sources. Future epidemiological studies, analysing symptomatic and asymptomatic SCCE patients, would be beneficial in providing accurate quantification of disease burden. Other future research directions include exploring intracranial stenting for CCE revascularisation and cerebral intravascular lithotripsy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spontaneous calcified cerebral emboli: a comprehensive review and proposed diagnostic criteria

Menounos,

Matar

2024

Front. Neurol.

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“…A case of transient ischemic attack secondary to CAVD, possibly secondary to calcific emboli affecting the cerebral arteries, has been reported 54 . Heyde syndrome, a well-known cardiac manifestation of CAVD, has been reported to present with iron deficiency anemia, possibly due to chronic gastrointestinal blood loss from the angiodysplasias that develop due to the disease 55 .…”

Section: Clinical Featuresmentioning

confidence: 99%

Insights into calcific aortic valve stenosis: a comprehensive overview of the disease and advancing treatment strategies

Jain,

Goyal,

Khan

et al. 2024

Annals of Medicine &Amp; Surgery

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Aortic valve stenosis is a disease characterized by thickening and narrowing of the aortic valve (AV), most commonly due to calcification, which leads to left ventricular outflow obstruction called calcific aortic valve disease (CAVD). CAVD presents as a progressive clinical syndrome with cardiorespiratory symptoms, often with rapid deterioration. The modern-day pathophysiology of CAVD involves a complex interplay of genetic factors, chronic inflammation, lipid deposition, and valve calcification, with early CAVD stages resembling atherosclerosis. Various imaging modalities have been used to evaluate CAVD, with a recent trend of using advanced imaging to measure numerous AV parameters, such as peak jet velocity. Significant improvements in mortality have been achieved with transcatheter AV repair, but numerous therapeutics and modalities are being researched to delay the progression of CAVD. This article aims to provide a comprehensive review of CAVD, explore recent developments, and provide insights into future treatments with various novel modalities.

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Transient ischemic attack due to multiple spontaneous calcified embolus of the cerebral arteries on a calcified mitral and aortic stenosis

Cited by 2 publications

References 9 publications

Spontaneous calcified cerebral emboli: a comprehensive review and proposed diagnostic criteria

Spontaneous calcified cerebral emboli: a comprehensive review and proposed diagnostic criteria

Insights into calcific aortic valve stenosis: a comprehensive overview of the disease and advancing treatment strategies

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