Pearls & Oy-sters: Calcified Cerebral Embolus: A Smoking Gun Guiding Acute Stroke Therapy and Secondary Prevention
Bibliographic record
Abstract
Although rarely found among patients with acute ischemic stroke, calcified cerebral emboli provide diagnostic information on potential stroke etiologies to guide secondary prevention.cIn the presence of a calcified cerebral embolus, all potential sources of calcific embolism should be investigated, including the aortic valve, aortic arch, and major neck vessels. Oy-sters cReperfusion therapy can be challenging in patients with acute stroke and calcified cerebral emboli.IV thrombolysis has a low chance of being successful but should not be withheld.Endovascular treatment performed with a direct aspiration first-pass technique may improve the chances of a successful outcome.A 78-year-old man presented with sudden-onset right-sided face and arm weakness and dysarthria.Upon arrival, at 60 minutes after symptoms onset, his NIH Stroke Scale (NIHSS) score was 4 (minor right facial paralysis, right arm drift, limb ataxia present in 1 limb, and mild to moderate dysarthria).His medical history was relevant for type 2 diabetes, hypertension, coronary artery bypass graft, and former smoking.Two weeks prior to the stroke, he experienced transient vertigo and disequilibrium, which were still present at the time of his admission, although with milder intensity.Medications included aspirin 81 mg/d, telmisartan 80 mg/d, amlodipine 10 mg/d, atenolol 50 mg/d, atorvastatin 10 mg/d, coenzyme Q10 100 mg/d, and metformin 2,000 mg/d.CT of the head showed a subtle hypodensity involving the posterior aspect of the left insular ribbon, an Alberta Stroke Program Early CT Score of 9, and a punctate hyperdensity (maximum density of 531 Hounsfield units) within the left Sylvian fissure, consistent with a calcified cerebral embolus (CCE) (figure ,A).There was also a recent (≤2 weeks) probable infarction involving the left pons.Head and supra-aortic vessels CT angiogram showed a 29 × 9 mm soft and calcified (443-1,261 Hounsfield units) aortic arch atherosclerotic plaque (figure ,E) and 70% right internal carotid artery stenosis, mild left internal carotid nonstenotic plaque, and occluded left middle cerebral artery (MCA) at its mid-distal M2 portion.On multiphase arterial images, there was attenuation of the left MCA proximal to a thrombus with a calcific component, delayed washout, and a multiphase CT angiography collateral score of 3. Perfusion imaging showed a large area of potentially reversible ischemia within the posterior aspect of the left MCA territory (figure S1, available from Dryad, doi.org/10.5061/dryad.sqv9s4n1j).We considered using IV tissue plasminogen activator (tPA) but in light of a probable subacute infarction involving the left pontine region (figure S2, available from Dryad, doi.org/10.5061/dryad.sqv9s4n1j) matching the persistent vertigo, we decided to omit IV.The right arm weakness
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.015 | 0.008 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".