A case of calcified cerebral emboli during hemodialysis

Abstract

A 65–year–old man suddenly developed dysarthria and right upper limb weakness during hemodialysis. His medical history included hypertension, diabetes mellitus, dyslipidemia, and maintenance hemodialysis for end–stage renal disease due to nephrosclerosis. Non–contrast brain computed tomography (CT) revealed a calcified embolus in the left middle cerebral artery branch. New cerebral infarcts were detected in the left frontal lobe on diffusion–weighted magnetic resonance imaging. After excluding other potential causes of cardiogenic cerebral or paradoxical embolism, a diagnosis of calcified cerebral emboli (CCE) was made based on the findings of multiple calcified lesions in the aortic valve, aortic arch, and base of the bilateral internal carotid artery on non–contrast chest CT, transthoracic echocardiography, and carotid echocardiography. In patients on dialysis with severe arterial wall calcification, non–contrast brain CT should be carefully reviewed, and CCE should be considered as a possible cause of cerebral infarction.