A 75-year-old woman with a history of hypertension, dyslipidemia, and atrial fibrillation on warfarin presented with sudden-onset confusion. A brain CT was read as normal. The international normalized ratio (INR) was 3.4. She was discharged home after resolution of her symptoms. Two weeks later, she presented with sudden-onset anomia and a right facial droop. The INR was 3.2. A new brain CT revealed multiple calcific emboli (figure, B). A CT angiogram showed a large atheromatous plaque within the aortic arch extending into the origin of the brachiocephalic artery (figure, C). Retrospectively, the initial CT already showed a calcified embolus (figure, A). Calcified cerebral emboli are frequently overlooked.1 Underlying sources may carry a high risk of recurrent embolism. Their early identification allows appropriate workup and treatment.

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