Isolated middle cerebral artery dissection: a systematic review

Area of Science:

• Neurology
• Vascular Neurology
• Cerebrovascular Diseases

Background:

• Acute stroke can be challenging to diagnose, especially in younger individuals with subtle symptoms.
• Cervicocephalic dissections are a recognized cause of stroke in young patients.
• Isolated middle cerebral artery dissection (MCAD) is a rare but significant etiology.

Purpose of the Study:

• To review the clinical implications and pathophysiology of isolated MCAD.
• To characterize the features and outcomes of patients with isolated MCAD.
• To identify potential areas for further research in managing this rare condition.

Main Methods:

• Systematic literature search of MEDLINE, HighWire, and Google Scholar (1966-2013).
• Keywords included 'middle cerebral artery dissection,' 'intracerebral artery dissection,' and 'middle cerebral artery dissection stroke.'
• Review of 61 cases from 54 publications to analyze patient characteristics and outcomes.

Main Results:

• A total of 61 cases were reviewed (62.3% male, mean age 44.16 ± 19.17 years).
• Most cases originated from Asian countries (78.7%); ischemic strokes were more common (68.9%).
• Digital subtraction angiography was the primary diagnostic tool (75.4%), and surgery was the preferred intervention (39.3%).

Conclusions:

• Isolated MCAD is a rare condition contributing to stroke in young patients.
• Males and those with ischemic presentations showed better outcomes.
• Further research is essential to define optimal treatment and outcomes for isolated MCAD.