Multiple Cardioembolic Strokes Caused by Caseous Calcification of the Mitral Annulus.

• Mitral annular calcification (MAC) is a common echocardiographic finding, estimated at around 14%, and occurs especially in elderly women. • Caseous calcification of the mitral annulus (CCMA) is a rare subvariant of MAC, with an echocardiographic prevalence of 0.6% and necropsy prevalence of about 2.3%. • CCMA, just like MAC, is believed to be associated with a high calcium score, coronary artery disease, aortic valve disease, atrial fibrillation, and hypertension. • CCMA can be confused echocardiographically with infective endocarditis, tumors, and cysts. • The decision for surgical treatment of CCMA is based on clinical judgment with factors such as valvular dysfunction and/or the propensity for stroke.