Acute Cerebral Infarction Secondary to Spontaneous Isolated Middle Cerebral Artery Dissection: A Case Report

Spontaneous isolated middle cerebral artery dissection (MCAD) is uncommon. We report a rare case of acute M1 occlusion resulting from spontaneous isolated MCAD. A 64-year-old man was admitted to our hospital with an abrupt onset of headache, left hemiparesis, and sensory disturbances. Magnetic resonance imaging revealed a cerebral infarction in the right hemisphere, and magnetic resonance angiography confirmed right M1 occlusion. The patient underwent mechanical thrombectomy and percutaneous transluminal angioplasty, achieving incomplete recanalization with residual stenosis. Retrospective analysis of angiography after the initial pass revealed findings suggestive of MCAD, indicating spontaneous isolated dissection. Reports of mechanical thrombectomy in patients with complete occlusion due to spontaneous isolated MCAD are limited, and the optimal treatment strategy remains unclear. Although diagnosing this rare condition is challenging, the presence of headache at onset may indicate MCAD. This case highlights the importance of considering spontaneous isolated MCAD as a possible cause of acute M1 occlusion and underscores the need for careful assessment of clinical history and imaging findings.