{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T13:24:49Z","timestamp":1792848289295,"version":"4.5.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T00:00:00Z","timestamp":1721174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Spontaneous calcified cerebral emboli (SCCE) secondary to aortic valve calcification are a rare and underreported cause of acute ischaemic stroke. Only five cases of SCCE secondary to bicuspid aortic valve calcification have been reported in the literature. This review includes a unique case example of acute ischaemic stroke secondary to SCCE, as the first manifestation of a calcified bicuspid aortic valve. This is the first clinical case of calcified cerebral emboli (CCE) associated with borderzone infarction (\u2018cortical ribbon sign\u2019). Whilst previously assumed that most CCE are secondary to iatrogenic causes, recent literature suggests the majority of CCE are spontaneous and clinically silent. Despite CT imaging widely considered the \u2018gold standard\u2019 for diagnosis, CCE are frequently misdiagnosed and missed entirely. Misdiagnosis of CCE may have catastrophic consequences due to the high risk of recurrence and missed opportunity to prevent neurological disability and death. This review presents a revised CCE diagnostic criteria, using evidence that has emerged over the last decade to create both Compulsory (Major) and Supporting (Minor) criteria. Current CCE management is not evidence based and remains largely speculative. SCCE may be the first manifestation of cardiac or vascular disease and diagnosis should trigger aggressive treatment of emboligenic sources. Future epidemiological studies, analysing symptomatic and asymptomatic SCCE patients, would be beneficial in providing accurate quantification of disease burden. Other future research directions include exploring intracranial stenting for CCE revascularisation and cerebral intravascular lithotripsy.<\/jats:p>","DOI":"10.3389\/fneur.2024.1401820","type":"journal-article","created":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T04:59:53Z","timestamp":1721192393000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Spontaneous calcified cerebral emboli: a comprehensive review and proposed diagnostic criteria"],"prefix":"10.3389","volume":"15","author":[{"given":"Spiro","family":"Menounos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid","family":"Matar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1161\/01.CIR.27.2.197","article-title":"Spontaneous calcific embolization associated with calcific aortic stenosis","volume":"27","author":"Holley","year":"1963","journal-title":"Circulation"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.3174\/ajnr.A3892","article-title":"Calcified cerebral emboli, a \"do not miss\" imaging diagnosis: 22 new cases and review of the literature","volume":"35","author":"Walker","year":"2014","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1111\/1754-9485.12730","article-title":"Calcified cerebral emboli: incidence and implications","volume":"62","author":"Bardon","year":"2018","journal-title":"J Med Imaging Radiat Oncol"},{"key":"ref4","first-page":"19","article-title":"Spontaneous calcific cerebral emboli from calcified aortic valve stenosis","volume":"20","author":"Vernhet","year":"1993","journal-title":"J Neuroradiol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.nrl.2019.04.004","article-title":"Calcified cerebral embolism: a 9-case series and review of the literature","volume":"37","author":"Mosqueira","year":"2022","journal-title":"Neurologia"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.neurad.2022.02.006","article-title":"Benefit of mechanical thrombectomy in acute ischemic stroke related to calcified cerebral embolus","volume":"49","author":"Grand","year":"2022","journal-title":"J Neuroradiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"464","DOI":"10.3174\/ajnr.A6412","article-title":"Endovascular Thrombectomy of calcified emboli in acute ischemic stroke: a multicenter study","volume":"41","author":"Maurer","year":"2020","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.3171\/2020.9.JNS201798","article-title":"Endovascular treatment for calcified cerebral emboli in patients with acute ischemic stroke","volume":"135","author":"Bruggeman","year":"2021","journal-title":"J Neurosurg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"106079","DOI":"10.1016\/j.clineuro.2020.106079","article-title":"Juvenile stroke caused by calcific bicuspid aortic valve: a case report","volume":"195","author":"Thunstedt","year":"2020","journal-title":"Clin Neurol Neurosurg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2899","DOI":"10.1016\/j.radcr.2022.05.043","article-title":"Transient ischemic attack due to multiple spontaneous calcified embolus of the cerebral arteries on a calcified mitral and aortic stenosis","volume":"17","author":"Taoussi","year":"2022","journal-title":"Radiol Case Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"816","DOI":"10.4103\/0028-3886.344606","article-title":"Beware of brain pearl-virtually missed a large vessel occlusion guided by CT perfusion","volume":"70","author":"Mahajan","year":"2022","journal-title":"Neurol India"},{"key":"ref12","first-page":"1996","article-title":"Calcified cerebral emboli","volume":"27","author":"Kavanagh","year":"2006","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e319","DOI":"10.1161\/STROKEAHA.108.538009","article-title":"Showered calcific emboli to the brain, the 'salted pretzel' sign, originating from the ipsilateral internal carotid artery causing acute cerebral infarction","volume":"40","author":"Christian","year":"2009","journal-title":"Stroke"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1136\/jnnp.2007.140749","article-title":"Neurological pictures. 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