Stroke as the first manifestation of calcific aortic stenosis

Heart valve calcifications are rarely recognized as a potential source for cerebral embolism. Previous studies have identified mitral, but not aortic, valve calcifications to be risk factors for stroke. Based on these studies , heart surgery is unlikely to be indicated in patients who present with a stroke and an 'incidental' aortic valve calcification. We report a case of a 46-year-old man presenting with acute onset of left-sided weakness and nu mbness. A previous smoking history was the only cardiovascular risk factor found. Head CT scan revealed a right middle cerebral artery territory infar ct and an adjacent high-density lesion. CT angiography demonstrated the pre sence of calcific embolic material in the middle cerebral artery. A search for embolic sources revealed a calcific aortic stenosis (CAS). initially pl aced on coumadin, the patient developed silent myocardial infarction 2 mont hs later, presumed to be also embolic in origin from the CAS. After aortic valve replacement, the patient has been symptom-free during a 2-year follow -up. In conclusion, CT angiography may be the method of choice for detectin g calcific cerebral emboli, and demonstration of a causal relationship betw een CAS and an embolic stroke by CT angiography may be an important adjunct in surgical decision-making. Copyright (C) 2000 S. Karger AG, Basel.