Infarctus cérébral par embolie calcaire : complication spontanée révélatrice d’un rétrécissement aortique calcifié

doi:10.1016/S0035-3787(04)70992-3

Revue Neurologique

Volume 160, Issue 5, Part 1, May 2004, Pages 582-584

https://doi.org/10.1016/S0035-3787(04)70992-3 Get rights and content

Résumé

Le rétrécissement aortique calcifié (RaoC) est une cause rare d’infarctus cérébral. La présence de calcifications cérébrales intra-vasculaires ou intra-parenchymateuses, symptomatiques ou non, doit faire évoquer le diagnostic de RaoC. Nous rapportons deux cas d’accidents vasculaires cérébraux ischémiques par embolies calcaires spontanées dans un contexte de RaoC et soulignons l’intérêt du scanner X cérébral dans cette pathologie.

Summary

Calcified aortic stenosis (CAS) is an unusual cause of cerebral infarct. The presence of cerebral intra-vascular or intra-parenchymatous calcifications, symptomatic or not, is suggestive of the diagnosis of CAS. We report two patients who experienced stroke induced by spontaneous calcic emboli from a calcified aortic valve and underline the importance of brain CT scan.

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There are more references available in the full text version of this article.

Cited by (7)

Stroke due to a spontaneous calcific cerebral emboli
2012, Pratique Neurologique - FMC
Les infarctus cérébraux sur emboles calciques sont rares, principalement décrits au décours de gestes endovasculaires dans un contexte de rétrécissement aortique calcifié. Seuls quelques cas d’infarctus cérébraux sur emboles calciques spontanés d’origine carotidienne sont rapportés dans la littérature. Nous rapportons le cas clinique, radiologique et pathologique d’un homme de 75 ans ayant présenté un infarctus sylvien gauche sur embolie calcique spontanée provenant d’une plaque d’athérome calcifiée de la carotide interne ipsilatérale. Le scanner X était l’examen clé du diagnostic.
Among the numerous etiologies of stroke, calcific cerebral emboli are rare, mostly described in the literature in the context of endovascular manoeuvres involving aortic valve calcified stenosis. Only a few cases of spontaneous calcific cerebral emboli from the carotid artery have been reported so far. We report the clinical, radiological, and pathological features observed in a 75-year-old man who had a left middle cerebral artery stroke due to calcific cerebral embolism from a calcified plaque in the ipsilateral internal carotid. The CT scan provided the key to diagnosis.
Calcific aortic valve and spontaneous embolic stroke: A review of literature
2009, Journal of the Neurological Sciences
Aortic valve calcification is common in the elderly and in patients with congenital bicuspid aortic valve but unlike calcific mitral valve disease it is not a well recognized risk factor for stroke. Although autopsy studies have revealed evidence of systemic embolism in one-third of cases with calcific aortic valves, there is conflicting data from larger clinical studies examining the association between calcific aortic valve and stroke. There are only 8 reported cases of symptomatic stroke from spontaneous cerebral thromboembolism associated with calcific aortic valve in the literature.
Computerized tomography (CT) angiography and CT without contrast are modalities of choice to diagnose calcific embolism, while MRI may be useful in delineating the extent of ischemia. Ideal management strategy, the role of antiplatelet therapy, anticoagulation or recommendations for valve replacements are poorly defined. We present a focused literature review on this topic.
Stroke due to spontaneous calcified cerebral embolus as presenting feature of calcified aortic stenosis
2008, Journal des Maladies Vasculaires
Nous rapportons un cas de rétrécissement aortique calcifié (RAC) à l’origine d’une ischémie cérébrale. Un homme de 81 ans, hypertendu, hypercholestérolémique et insuffisant rénal, présentait une hémiparésie droite et une aphasie soudaines. Le scanner cérébral montrait un embole de tonalité calcique dans une branche de l’artère cérébrale antérieure gauche et un infarctus cérébral dans le territoire correspondant. Le bilan étiologique mettait en évidence un rétrécissement aortique calcifié et une athéromatose aortique et carotidienne modérée. L’évolution clinique était favorable et le patient bénéficiait d’un traitement associant un antiplaquettaire et une statine. L’embolie calcaire est une cause rare d’accident vasculaire cérébral et n’a jamais été rapportée dans le territoire de l’artère cérébrale antérieure. Les calcifications peuvent provenir des valves cardiaques ou de plaques athéromateuses, aortiques ou carotidiennes. L’insuffisance rénale favorise leur développement, à l’origine d’une augmentation du risque cardiovasculaire. Le RAC n’est pas considéré comme un facteur de risque d’ischémie cérébrale, sauf en cas de sténose serrée ou d’une hypertrophie ventriculaire associées.
We report a case of calcified aortic stenosis revealed by an ischemic stroke. An 81-year-old man with hyperlipidemia, hypertension and renal function impairment presented with acute onset of right-sided hemiparesis and aphasia. Head CT scan revealed a rounded calcified high-density mass within the distal segment of the left anterior cerebral artery, consistent with a calcified cerebral embolus, and an infarct in the left paracentral lobule. Transesophageal echocardiography demonstrated a sclerotic aortic valve. The patient was discharged from hospital on aspirin and atorvastatin, and the outcome was favorable. Calcified embolus remains a rare event and it has been not yet reported in the territory of anterior cerebral artery. It may be observed in aortic and mitral valve diseases, calcified plaques of the internal carotid artery and aortic arch. Renal failure promotes their development and is the cause of cardiovascular diseases. To date, aortic valve calcification is not considered as a marker of stroke risk, except when associated with severe stenosis or left ventricular hypertrophy.
Calcified cerebral emboli, a "do not miss" imaging diagnosis: 22 New cases and review of the literature
2014, American Journal of Neuroradiology
Stroke with calcium emboli related to a calcified stenosis of internal carotid artery
2008, Journal of Neurology, Neurosurgery and Psychiatry
Cardioembolic stroke: An update on etiology, diagnosis and management
2008, Annals of Indian Academy of Neurology

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Brève communicationInfarctus cérébral par embolie calcaire : complication spontanée révélatrice d’un rétrécissement aortique calcifiéCerebral infraction by calcified embolism: a spontaneous complication of calcified aortic stenosis

Résumé

Summary

Risk of stroke in a cohorte of 815 patients with calcifications of the aortic valve with or without stenosis

Stroke

Association of aortic stenosis with platelet hyperagregability and impairement responsiveness to nitric oxide

Am J Cardiol

Evaluation of aortic atherosclerosis by transoesophagial echocardiography. Pronostic, implications

Arch Mal Coeur Vaiss

Calcific cerebral emboli and aortic stenosis: Detection of computed tomography

Stroke

Calcific cerebral embolism in systematic calciphylaxis

Neurology

Computed tomography detection of a cerebral calcific embolus following coronary catheterization

J Neuroimaging

Brève communication
Infarctus cérébral par embolie calcaire : complication spontanée révélatrice d’un rétrécissement aortique calcifiéCerebral infraction by calcified embolism: a spontaneous complication of calcified aortic stenosis