{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:11Z","timestamp":1756339511103,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T00:00:00Z","timestamp":1700265600000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,11,2]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:p>A woman in her 70s was admitted for acute, painless vision loss in the left eye. Examination showed cherry red spot in the macula and plaque in the nasal vessels, consistent with central retinal artery occlusion. MRI orbits revealed multifocal subclinical acute infarcts in the right middle cerebral artery (MCA) territory and bilateral cerebella. Transthoracic echocardiogram showed calcification of the anterolateral papillary muscle. Further characterisation with cardiac MRI elucidated caseous \u2018toothpaste-like\u2019 calcification of the muscle complex. Stroke workup was otherwise unremarkable. The patient underwent hyperbaric treatment with mild improvement. Anticoagulation and surgical intervention were deferred due to known risks and unknown benefit for calcific emboli. The patient was continued on her home dual anti-platelet therapy (DAPT) and discharged with a loop monitor. Caseous calcification of the papillary muscle (CCPM) may be a risk factor for cardioembolic stroke. Further discussions on medical and surgical guidelines for CCPM would be beneficial for stroke prevention.<\/jats:p>","DOI":"10.1136\/bcr-2022-254549","type":"journal-article","created":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T20:45:15Z","timestamp":1700253915000},"page":"e254549","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cardioembolic stroke in the setting of diffuse caseous calcification of the anterolateral papillary muscle"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3641-8778","authenticated-orcid":false,"given":"Rahul","family":"Gaini","sequence":"first","affiliation":[{"name":"Neurology, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Le","sequence":"additional","affiliation":[{"name":"Neurology, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,11,17]]},"reference":[{"key":"2025082708274685000_16.11.e254549.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(21)00252-0"},{"key":"2025082708274685000_16.11.e254549.2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.24.1.35"},{"key":"2025082708274685000_16.11.e254549.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199208063270602"},{"key":"2025082708274685000_16.11.e254549.4","doi-asserted-by":"publisher","DOI":"10.1067\/mje.2001.111877"},{"key":"2025082708274685000_16.11.e254549.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2007.12.004"},{"key":"2025082708274685000_16.11.e254549.6","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.case.2017.01.002","article-title":"Multiple cardioembolic strokes caused by caseous calcification of the mitral annulus","volume":"1","author":"Goldberg","year":"2017","journal-title":"CASE (Phila)"},{"key":"2025082708274685000_16.11.e254549.7","first-page":"e141","article-title":"A case of caseous calcification of the mitral annulus: a potential source of embolic stroke","volume":"2","author":"Higashi","year":"2010","journal-title":"J Cardiol Cases"},{"key":"2025082708274685000_16.11.e254549.8","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.neurol.2014.07.019","article-title":"Caseous calcification of the mitral annulus associated with stroke: report of two cases","volume":"171","author":"Sagnier","year":"2015","journal-title":"Rev Neurol (Paris)"},{"key":"2025082708274685000_16.11.e254549.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.872"},{"key":"2025082708274685000_16.11.e254549.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.12.041"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-254549","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:27:52Z","timestamp":1756308472000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-254549"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":10,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,17]]},"published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1136\/bcr-2022-254549"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-254549","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}