Stroke due to spontaneous calcified cerebral embolus as presenting feature of calcified aortic stenosis

We report a case of calcified aortic stenosis revealed by an ischemic stroke. An 81 year-old man with hyperlipdemia, 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 embotus, and an infarct in the left paracentral lobule. Transesophagea[ 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.(c) 2008 Elsevier Masson SAS. Tous droits reserves.