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Calcified cerebral emboli: the salted pretzel sign
  1. Bárbara Alves Rodrigues1,
  2. Marta Magriço1,
  3. Inês Carmo e Pinto1,
  4. Pedro Vilela2,
  5. João Pedro Marto1,3
  1. 1Neurology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
  2. 2Neuroradiology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
  3. 3iNOVA4Health, NOVA University Lisbon NOVA Medical School, Lisboa, Portugal
  1. Correspondence to Dr Bárbara Alves Rodrigues, Neurology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, 1349-019, Portugal; barodrigues{at}chlo.min-saude.pt

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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 …

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Footnotes

  • 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.