Related Experiment Video
Updated: May 26, 2026
Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
An unexpected evolution of symptomatic mild middle cerebral artery (MCA) stenosis: asymptomatic occlusion
Giovanni Malferrari1, Marialuisa Zedde, Gianni De Berti
1Neurology Unit, Department of Neuromotor Physiology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42100 Reggio Emilia, Italy.
Background:
The intracranial localization of large artery disease is recognized as the main cause of ischemic stroke in the world, considering all countries, although its global burden is widely underestimated. Indeed it has been reported more frequently in Asians and African-American people, but the finding of intracranial stenosis as a cause of ischemic stroke is relatively common also in Caucasians. The prognosis of patients with stroke due to intracranial steno-occlusion is strictly dependent on the time of recanalization. Moreover, the course of the vessel involvement is highly dynamic in both directions, improvement or worsening, although several data are derived from the atherosclerotic subtype, compared to other causes.
Case Description:
We report the clinical, neurosonological and neuroradiological findings of a young woman, who came to our Stroke Unit because of the abrupt onset of aphasia during her work. An urgent neurosonological examination showed a left M1 MCA stenosis, congruent with the presenting symptoms; magnetic resonance imaging confirmed this finding and identified an acute ischemic lesion on the left MCA territory. The past history of the patient was significant only for a hyperinsulinemic condition, treated with metformine, and a mild overweight. At this time a selective cerebral angiography was not performed because of the patient refusal and she was discharged on antiplatelet and lipid-lowering therapy, having failed to identify autoimmune or inflammatory diseases. Within 1 month, she went back to our attention because of the recurrence of aphasia, lasting about ten minutes. Neuroimaging findings were unchanged, but the patient accepted to undergo a selective cerebral angiography, which showed a mild left distal M1 MCA stenosis.During the follow-up the patient did not experienced any recurrence, but a routine neurosonological examination found an unexpected evolution of the known MCA stenosis, i.e. left M1 MCA occlusion. Neuroradiological imaging did not identify new lesions of the brain parenchyma and a repeated selective cerebral angiography confirmed the left M1 MCA occlusion.
Conclusions:
Regardless of the role of metabolic and/or inflammatory factors on the aetiology of the intracranial stenosis in this case, the course of the vessel disease was unexpected and previously unreported in the literature at our knowledge.
Insights
Intracranial stenosis, a major cause of ischemic stroke, can rapidly progress to occlusion. This case highlights the unpredictable nature of cerebral artery disease, even in young individuals, emphasizing the need for vigilant monitoring.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Intracranial large artery disease is a leading cause of ischemic stroke globally, with its burden often underestimated.
- While more prevalent in certain ethnicities, intracranial stenosis affects various populations and requires timely recanalization for better patient outcomes.
- The dynamic nature of intracranial vessel involvement, whether improving or worsening, is crucial for prognosis, though data often focuses on atherosclerotic causes.
Observation:
- A young woman presented with aphasia due to acute left middle cerebral artery (MCA) stenosis.
- Initial neurosonology and MRI confirmed stenosis and ischemic lesions; however, cerebral angiography was initially declined.
- Recurrent transient aphasia led to angiography revealing mild stenosis, which later progressed to complete left M1 MCA occlusion despite medical therapy.
Findings:
- The case details a young woman with a history of hyperinsulinism and overweight, presenting with transient ischemic attack symptoms.
- Initial diagnosis of left M1 MCA stenosis evolved unexpectedly to complete occlusion within a month, confirmed by repeated angiography.
- No new ischemic lesions were identified despite the progression to occlusion, and autoimmune/inflammatory causes were ruled out.
Implications:
- This case underscores the potential for rapid and unexpected progression of intracranial stenosis to occlusion, even in young patients without typical risk factors.
- The findings challenge existing understanding of the natural history of non-atherosclerotic intracranial artery disease.
- Continuous neurovascular monitoring may be essential for patients with intracranial stenosis, given its unpredictable course.
Related Concept Videos
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:26Transient Ischemic Attack l: Introduction
01:22Mitral Stenosis I: Introduction