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[Case with multiple brain infarcts due to calcified emboli from a calcified atheroma of the innominate artery].

A 75-year-old-woman was admitted to our hospital because of acute brain infarction with symptoms of vertigo, conjugate deviation of the eyes, speech disturbances, left hemiparesis, and right limb ataxia. On admission, diffusion-weighted MR imaging revealed a high-intensity area in the right internal carotid artery (ICA) and vertebrobasilar (VB) territories. MRA showed normal intracranial arteries. Ultrasonography with a sector probe (2MHz) showed a mobile mass with an acoustic echo in the innominate artery. Contrast-enhanced computed tomography showed a calcified mass in the innominate artery. Despite full-dose antithrombotic therapy, recurrent attacks could not be prevented. Replacement of the innominate artery was performed by cardiac surgeons, and a ruptured calcified plaque was found in the innominate artery. Subsequent, computed tomography of the brain showed calcified emboli in the right ICA and VB territories. Arterial ultrasonography appears to be very useful in evaluating the innominate artery. On finding calcified emboli, an embolic source should be searched for in the aorta, heart valves, and the innominate artery. When infarcts with calcified emboli are found only in the right ICA and VB territories, the innominate artery should be explored by ultrasonography for the presence of a calcified atheroma.