Current Journal of Neurology

Rapid dystrophic calcification mimicking hemorrhagic transformation after postoperative cerebral infarction: A case report

Articles in Press

Document Type : Clinical Notes

Author

Kyusik Kang

Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Hangeulbiseok-ro, Nowon-gu, Seoul, Republic of Korea

Abstract
Background: Dystrophic calcification is a rare complication of cerebral infarction. This study presents the case of a 67-year-old man with a postoperative stroke who developed dystrophic calcification.
Case Report: A 67-year-old man with atrial fibrillation (AF) underwent surgery for a femoral fracture. On postoperative day 2, he developed acute right arm paralysis, and diffusion-weighted imaging (DWI) showed acute infarction in the left posterior cerebral artery (PCA) territory. Apixaban was initiated. On postoperative day 12, follow-up computed tomography (CT) showed focal hyperdensity prompting apixaban discontinuation. However, serial imaging revealed progressive hyperattenuation with cortical ribbon distribution, absence of mass effect, and clinical stability.
Conclusion: This case highlights the diagnostic challenge and importance of multimodal imaging in differentiating dystrophic calcification from hemorrhagic transformation, particularly when managing anticoagulated patients. Recognition of temporal evolution, attenuation values, and anatomical distribution—alongside the absence of clinical deterioration—is essential for making appropriate therapeutic decisions.

Keywords

Cerebral Infarction
Computed Tomography
Dystrophic Calcification
Ischemic Stroke
Magnetic Resonance Imaging
Subjects
  1. Duncan IC, Sher BJ. Dystrophic calcification in an old cerebral infarction. S Afr J Radiol 2003; 7(2): 48-9.
  2. Bharath J, Reddy VN, Nagarajan K, Adithan S, Pillai VM. Calcifications in Cerebral Infarcts: Report of Two Cases. J Stroke Med 2023; 6(1): 64-8.
  3. Ju R, Shi J. Rapid calcification after large area cerebral infarction. Panminerva Med 2023; 65(4): 539-40.
  4. Parisi J, Place C, Nag S. Calcification in a recent cerebral infarct--radiologic and pathologic correlation. Can J Neurol Sci 1988; 15(2): 152-5.
  5. Qiu Y, Mo C, Xu S, Chen L, Ye W, Kang Y, et al. Research progress on perioperative blood-brain barrier damage and its potential mechanism. Front Cell Dev Biol 2023; 11: 1174043.
  6. Morales H. Pitfalls in the Imaging Interpretation of Intracranial Hemorrhage. Semin Ultrasound CT MR 2018; 39(5): 457-68.
  7. Sener RN. Gyral calcifications detected on the 45th day after cerebral infarction. Pediatr Radiol 1993; 23(7): 570-1.
  8. Wityk RJ, Lapeyrolerie D, Stein BD. Rapid brain calcification after ischemic stroke. Ann Intern Med 1993; 119(6): 490-1.
Current Journal of Neurology

Articles in Press, Accepted Manuscript
Available Online from 06 September 2026

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