Caseous calcification of the mitral annulus was identified as the plausible source of a calcified cerebral embolus causing acute stroke in a 33-year-old man with end-stage renal disease.
Case Report (n=1)
Caseous calcification of the mitral annulus can be a rare embolic source of stroke in young patients with end-stage renal disease, highlighting the diagnostic value of multimodality imaging.
Abstract Background Caseous calcification of the mitral annulus (CCMA) is a rare form of mitral annular calcification and may be an embolic source, particularly in end-stage renal disease (ESRD). Case summary A 33-year-old man with ESRD on hemodialysis presented with acute left middle cerebral artery stroke (NIHSS 21). Brain CT angiography showed a dense calcified embolus occluding the proximal M1 segment. Echocardiography and ECG-gated non-contrast cardiac CT identified two posterior annular lesions with a calcified rim and central low attenuation, consistent with CCMA. The close radiological match between the intracranial calcified embolus and the annular lesions suggested CCMA as the most plausible source. Surgical excision was deferred after multidisciplinary discussion because of the high hemorrhagic risk related to the large recent infarction. The patient was managed conservatively with oral anticoagulation and strict blood pressure control. Discussion This case illustrates that CCMA may be a possible embolic source even in young dialysis patients. It underscores the diagnostic value of multimodality imaging and the importance of individualized multidisciplinary decision-making when weighing embolic and hemorrhagic risks.
Yahia et al. (Thu,) conducted a case report in Caseous calcification of the mitral annulus and embolic stroke (n=1). Caseous calcification of the mitral annulus was evaluated on Embolic stroke. Caseous calcification of the mitral annulus was identified as the plausible source of a calcified cerebral embolus causing acute stroke in a 33-year-old man with end-stage renal disease.