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J Korean Neurol Assoc. 1997;15(4):728-737.
- Pure Middle Cerebral Artery Occlusive Disease in Young Adults
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Jae-Hong Lee, M.D.
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Department of Neurology, Ulsan University College of Medicine
- 젊은 환자에서의 순수 중대뇌동맥 폐색성질환
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울산대학교 의과대학 신경과학교실
- 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.
Keywords :
- 초록
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