Early extensive gyral calcification in ischemic stroke

Excerpt

A 54-year-old woman with medical history of moderately differentiated breast cancer (pT1–N2–M1) and femoral metastasis was receiving zoledronic acid and taxol as treatment. She was admitted to the Emergency Room due to acute onset of drowsiness, dysarthria, and left homonymous hemianopsia, hemiparesis and spatial neglect. Computerized tomography (CT) showed signs suggestive of acute ischemic stroke in the right frontoparietal regions. After considering with the oncologist the vital prognosis and the low hemorrhagic risk, fibrinolisis with rt-PA was timely initiated and a good response was achieved. After 24 h, she was admitted to the Neurology Department, and a MRI confirmed an extensive ischemic stroke in the right middle cerebral artery territory (Fig. 1). After discharging, a control CT performed 1 month later as outpatient showed a remarkable hyperdensity in the cortical ribbon of the infarcted region, compatible with an extensive gyriform parenchymal calcification surrounding the ischemic area confirmed on the MRI (Fig. 2). Blood tests revealed mild increase of parathyroid hormone with normal values of calcium and phosphorus that was attributed to the bisphosphonates therapy. …