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.