71 year old woman presents to ER comatose, transferred from an outside hospital. History of diabetes, hypertension, and atrial fibrillation.
Coma. Responds to deep pain only.
â€¢ Calcified embolus distal basilar artery on CT and CTA.
â€¢ Multiple infarcts involving the thalami, left occipital lobe, brainstem and left cerebellar hemisphere.
â€¢ Brain infarction
â€¢ Calcified thrombus
â€¢ Embolized calcified plaque or cardiac valve vegetation
Dx: Cerebral infarction (basilar artery territory) secondary to calcified embolus from heart
Dx Confirmed by: History, Physical Examination, MRI and CT scans
Supportive only. Sadly, this patient died two days after presentation.
Cerebral infarction is one kind of stroke with tissue death that can be caused by any process that stops cellular metabolism. Most often this is vascular, caused by a reduction or interruption of normal blood flow. Infarction can also be caused by poisons and toxins (hexacholorophene, cyanide), low blood sugar (hypoglycemia), low oxygen (hypoxia), carbon monoxide (shifts the Hgb dissociation curve) etc.
Vascular causes of cerebral infarction are usually produced by arterial occlusions from an in situ thrombus or an embolus. Arterial infarctions usually follow known patterns of perfusion from blood flow maps (see link and diagram below}.
Venous occlusion causes infarction through stagnation and accumulation of deoxygenated blood in the brain. Venous infarcts have extremely variable patterns, and may be bilateral (e.g. after superior sagittal sinus thrombosis). Venous infarction often produces a significant deep and irregular parenchymal hemorrhage.
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