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Minor stroke and major vascular occlusion. A case report

A Maestroni1, C Mandelli, B Zecca

  • 1Department of Emergency Medicine, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena di Milano, Milan, Italy. alberto.maestroni@tiscali.it

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|August 10, 2006
PubMed

Insights

Middle cerebral artery (MCA) occlusion typically indicates severe stroke. However, this case shows mild stroke symptoms with MCA occlusion, highlighting the potential for recovery and the utility of non-invasive vascular imaging.

Area of Science:

  • Neuroscience
  • Vascular Neurology
  • Medical Imaging

Background:

  • Middle cerebral artery (MCA) occlusion is a major cause of severe ischemic stroke with poor prognosis.
  • Mild to moderate stroke presentations with MCA occlusion are rare but have been reported, often with neurological deficit reversibility.

Observation:

  • A 66-year-old male presented with mild stroke symptoms (left-side weakness, dysarthria; NIHSS score 7) that resolved within days.
  • Brain CT revealed an ischemic lesion in the right internal capsule.
  • Transcranial Colour Doppler demonstrated absent flow in the right MCA, confirmed by angiography showing MCA occlusion.

Findings:

  • The MCA occlusion was retrogradely revascularized by leptomeningeal collaterals, explaining the neurological deficit resolution.
  • Non-invasive intracranial vascular examinations successfully identified a major intracranial artery lesion in a patient with mild stroke symptoms.
  • This case underscores that MCA occlusion can occur in mild stroke presentations.

Implications:

  • Non-invasive vascular imaging techniques are valuable for diagnosing intracranial artery lesions in patients with mild stroke.
  • Identifying such patients allows for targeted follow-up to determine optimal treatment strategies and long-term prognosis.
  • Further research is warranted to understand the mechanisms and outcomes of MCA occlusion in mild stroke cases.

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