A 30-year old Chinese man initially presented in 2009 with left subcortical ischemic stroke. Patient had borderline hypertension but no history of diabetes mellitus or hyperlipidemia.
The case illustrates the occurrence of progressive intracranial stenosis in young patients, which is unlikely to be atherosclerotic in nature. The manifestation is relatively common in Asian population [1].
A. A hyper-intensity consistent with subcortical infarction in the left middle cerebral artery distribution.
B. A magnetic resonance angiogram demonstrated high-grade stenosis of the left middle cerebral artery involving M1 and M2 segments (see arrows). There appears to be stenosis in the supraclinoid segment of the left internal carotid artery.
C. In 2013, a repeat magnetic resonance angiogram demonstrated complete occlusion of the left middle cerebral artery and high-grade stenosis of the left middle cerebral artery involving M2 segments (arrows).
References
- Qureshi AI, Feldmann E, Gomez CR, Johnston SC, Kasner SE, Quick DC, Rasmussen PA, Suri MF, Taylor RA, Zaidat OO. Intracranial atherosclerotic disease: an update. Ann Neurol. 2009;66:730–8. doi: 10.1002/ana.21768. [DOI] [PubMed] [Google Scholar]