A 93-year-old right-handed woman was seen within an hour of acutely developing aphasia and right hemiplegia. She had a history of hypertension and hypercholesterolemia and had smoked 30 pack-years; medications included aspirin, hydrochlorothiazide, and amlodipine besylate. She had no history of arrhythmia.
Examination showed blood pressure of 140/65 mm Hg, a heart rate of 78 beats/min, and sinus rhythm. She had no cardiac murmurs and no carotid bruits. On neurological examination, she had global aphasia and severe right hemiplegia and her eyes were conjugately deviated to the left. Her National Institutes of Health Stroke Scale score was 16. The laboratory and electrocardiographic findings were normal.
Figure 1. Computed tomographic scans of the head showing multiple calcific emboli (arrows) in the left middle cerebral artery branches and loss of gray and white matter differentiation suggesting an acute infarct.
Figure 2. Computed tomographic angiograms of the neck showing calcified carotid arteries (arrows).
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