title: Stroke attributable to a calcific embolus from the brachiocephalic trunk.
abstract: OBJECTIVE
  Calcific brain embolization is a rare event that is usually secondary to cardiac valve calcification. We present a case of stroke caused by embolization of calcific material from the brachiocephalic trunk, probably induced by radiotherapy.
  
  
  METHODS
  A 56-year-old right-handed female developed left-sided hemiparesis, hemihypesthesia, and sensory inattention. She had a history of right breast carcinoma that was excised 8 years previously followed by radiotherapy. She had no other history of note. Computed tomography of the head and magnetic resonance imaging confirmed a calcific embolus in right middle cerebral artery and an acute infarction in the corresponding territory. Plain chest radiography, carotid ultrasonography, transthoracic and transoesophageal echocardiography failed to demonstrate the source of calcific embolism. Computed tomography of the thorax revealed heavy calcification of the brachiocephalic trunk and the origin of the right common carotid artery.
  
  
  CONCLUSIONS
  Undertaking a vigilant systematic search for the source in cases of calcific embolization is necessary. The aorta and its main branches are possible, yet unusual, sources of calcific emboli that merit investigation.
authors.affiliation: Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Ramez R
authors.initials: RR
authors.lastname: Moustafa
authors.forename: Nagui M
authors.initials: NM
authors.lastname: Antoun
authors.forename: Richard A
authors.initials: RA
authors.lastname: Coulden
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Warburton
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
mesh_terms: D050197:Atherosclerosis / Q000473:pathology; D001794:Blood Pressure; D016122:Brachiocephalic Trunk / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology; D004452:Echocardiography; D004617:Embolism / Q000473:pathology*; D004947:Esophagus / Q000473:pathology; D005260:Female; D006351:Heart Valves / Q000473:pathology*; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000473:pathology; D002542:Intracranial Embolism and Thrombosis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D020521:Stroke / Q000209:etiology / Q000473:pathology*; D013923:Thromboembolism / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography