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Acute spasticity in malignant MCA stroke: a case report and review of literature

Muhammad Faizan1, Azza Halfawi1, Alreem Alkuwari2

  • 1Emergency Medicine Department, Hamad General Hospital, Trauma and Emergency Center, Al Rayyan Road, Doha, Doha Municipality, 3050, Qatar.

Oxford Medical Case Reports
|July 28, 2025
PubMed

Insights

This case study highlights a rare instance of malignant Middle cerebral artery (MCA) infarction presenting with acute spasticity. It underscores the importance of recognizing atypical stroke symptoms and potential anabolic steroid risks.

Area of Science:

  • Neurology
  • Neuroscience
  • Vascular Neurology

Background:

  • Malignant Middle cerebral artery (MCA) infarction typically causes rapid neurological decline due to cerebral edema.
  • Spasticity is a common stroke sequela, usually appearing days to weeks post-event.

Observation:

  • A 40-year-old male presented with acute spasticity, aphasia, and reduced consciousness.
  • Computed tomography (CT) angiography confirmed left MCA occlusion.
  • Rapidly developing cerebral edema necessitated a decompressive hemicraniectomy (DH).

Findings:

  • This case details an exceptionally rare presentation of malignant MCA infarction with acute spasticity.
  • The patient had a history of smoking and androgenic anabolic steroid use.

Implications:

  • This case expands the clinical spectrum of stroke presentations.
  • It emphasizes the need for vigilance regarding atypical stroke symptoms and the potential contribution of anabolic steroids to stroke risk.
Keywords:
acute spasticityanabolic steroidscase reportcerebral edemadecompressive craniectomyischemic strokemalignant MCA infarctionstroke risk factors

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