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A 72-year-old man developed acute aphasia and right-sided hemiparesis. Initial non-contrast CT scan of the head showed multiple punctate calcifications along the brain surface in the territory of the left middle cerebral artery, and a calcific dot sign in the left Sylvian fissure (figure 1A,B). CT angiogram showed a high-grade left internal carotid artery stenosis due to calcified heterogenous carotid plaques (figure 1C) and a proximal M2 occlusion of the left middle cerebral artery. The patient received intravenous thrombolysis but was not suitable for endovascular treatment due to significant infarct extension after hospital transfer. Follow-up imaging showed an infarct exclusively …
Contributors All authors participated in this article equally.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Tom Hughes, Cardiff, UK.