Calcification in a Recent Cerebral Infarct - Radiologic and Pathologic Correlation

This 60 year old male developed a right hemiplegia and aphasia. A C.T. head scan showed a cerebral infarct which appeared hyperdense on a subsequent scan done 18 days after presentation. This was interpreted as indicating a hemorrhagic transformation resulting in discontinuation of anticoagulation therapy. At autopsy, the area of infarction in the left frontoparietal hemisphere appeared intensely green due to breakdown of the blood-brain barrier in the presence ofjaundice. A striking finding on microscopy was the presence of calcium salts throughout the area of infarction but most prominent in the grey matter at the periphery of the infarct corresponding to the areas which appeared hyperdense on the CT head scan and stained intensely with bilirubin. There was no evidence of recent hemorrhage. This case illustrates that calcification can occur within weeks after the onset of a recent cerebral infarct and should be considered when interpreting the development of C.T. scan hyperdensity in recent cerebral infarcts.