PMC8077171_01
Axial fluid attenuated inversion recovery (left) and diffusion weighted imaging (right) showing multiple areas of hypersignal and restricted diffusion consistent with multifocal recent ischaemia in the right middle cerebral artery territory.
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The PCP requested urgent cerebral magnetic resonance imaging (MRI) which showed recent multiple infarcts in the right middle cerebral artery (MCA) territory (Fig. 1).
(A) Axial contrast enhanced cerebral computed tomography cerebral angiogram (CTA) showing multiple calcified cerebral emboli in the right middle cerebral artery (B) Calcified embolus in the M3 segment of the right middle cerebral artery seen in multiplanar reconstruction (C) Axial cervical CTA showing a calcified right carotid plaque without significant stenosis (D) Three dimensional CTA reconstruction of the right carotid bifurcation.
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A computed tomography cerebral angiogram (CTA) revealed calcified cerebral emboli (CCE) in the right MCA territory (Fig. 2A) and an isolated calcified embolus in the M3 segment of the right MCA (Fig. 2B) which were not observed on the cerebral MRI. The CTA also showed a calcified right carotid bifurcation plaque without significant stenosis (Fig. 2C and D).
Cervical duplex ultrasound showing a mobile, ruptured internal carotid plaque (left). Per-operative findings showing the floating plaque through the carotid arteriotomy (right).
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American Symptomatic Carotid Endarterectomy Trial (NASCET) method (Fig. 3, Supplemental Video). An ulcerated atherosclerotic plaque located in the right carotid bifurcation (Fig. 3) was found.