Gyral Calcification in an Adult Masquerading as Subarachnoid Hemorrhage

Abstract

An 85-year-old female with a medical history significant for coronary artery disease, status post pacemaker placement, and a prior stroke presented to an outside emergency department (ED) with complaints of lethargy, diaphoresis, dysarthria, and an episode of transient loss of consciousness at her nursing home. There was no history of trauma and she was not on any anticoagulants. A computed tomography (CT) scan was performed and read by the ED physician as subarachnoid hemorrhage (SAH) in the left sylvian fissure, and the patient was emergently transferred to our hospital for further management with a tentative diagnosis of SAH. Upon arrival to our intensive care unit, she was following commands, oriented to self, dysarthric but with fluent speech. Cranial nerve examination was within normal limits except for the presence of rightsided upper motor neuron–type facial nerve palsy. Careful evaluation of the CT scan showed the presence of a serpentine hyperdensity along the left perisylvian cortex consistent with dystrophic calcification from prior ischemic insult rather than an SAH, along with chronic microvascular ischemic changes, old lacunar infarcts, and age-appropriate cerebral parenchymal volume loss (Figure 1). CT angiography performed as part of a