J Korean Neurol Assoc.  1997 Aug;15(4):728-737.

Pure Middle Cerebral Artery Occlusive Disease in Young Adults

• Lee JH

Abstract

BACKGROUND AND PURPOSE: The etiology and natural history of the isolated MCA stenosis or occlusion is uncertain, although its prevalence is relatively high in Korean population. It is especially true for young adult stroke patients. To investigate the etiology and clinical manifestation in young adult stroke patients (age < 45 years) with pure middle cerebral artery (MCA) occlusive disease.
METHODS
Fourteen cases of young adult stroke patients with angiographically-documented pure MCA occlusive disease were retrospectively reviewed. Clinical and radiological findings were all evaluated.
RESULTS
The mean age was 35.5 years (men 10, woman 4). Eleven (79%) of the 14 patients showed isolated MCA stem stenosis or occlusion and three (21%) had a combined stenosis in the distal internal carotid artery (ICA). On computed tomography (CT) or magnetic resonance imaging (MRI), 7 patients (50%) demonstrated intracranial hemorrhage (3 intraventricular, 2 subarachnoid, 2 intracerebral hemorrhages), whereas 6 (43%) showed infarction of various locations. One patient revealed no stroke lesion. With regard to intracranial hemorrhage patients, no stroke risk factors were found in any of them, nor the positive lab data, making it impossible to establish a specific etiology for stroke. One patient who had had unilateral stenosis of the distal ICA and the proximal MCA underwent repeat cerebral angiography 2 years later and it turned out that she had definite moyamoya disease with bilateral involvement of the occlusive lesion.
CONCLUSIONS
Intracranial hemorrhage was frequent in young adult stroke with pure MCA occlusive disease, which is quite unusual compared to young adult stroke in general. It suggests that some common, peculiar mechanism of stroke may be implicated in this patient population. With no specific risk factors involved and one illustrative case evolving into typical moyamoya disease, this unique population of stroke patients might represent a spectrum of moyamoya disease.

MeSH Terms

Carotid Artery, Internal
Cerebral Angiography
Constriction, Pathologic
Female
Humans
Infarction
Intracranial Hemorrhages
Magnetic Resonance Imaging
Middle Cerebral Artery*
Moyamoya Disease
Natural History
Prevalence
Retrospective Studies
Risk Factors
Stroke
Young Adult*