%0 Journal Article
%T An unexpected evolution of symptomatic mild middle cerebral artery (MCA) stenosis: asymptomatic occlusion
%A Giovanni Malferrari
%A Marialuisa Zedde
%A Gianni De Berti
%A Massimo Maggi
%A Norina Marcello
%J BMC Neurology
%D 2011
%I BioMed Central
%R 10.1186/1471-2377-11-154
%X 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.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.It has been known since several years that ischemic stroke related to large intracranial arteries steno-occlusion has a poor prognosis, if the vessel recanalization does not occur within 1 hour [1]. Indeed M1 MCA occlusion is recognized to be a very harmful condition with an unfavorable outcome. Several papers reported the rate and course of both symptomatic and asymptomatic in
%U http://www.biomedcentral.com/1471-2377/11/154