Hemorrhage with dolichoectatic middle cerebral arteries

Middle cerebral artery dolichoectasia with radiologic follow-up

Intracranial dolichoectasia is an angiopathy characterized by dilation, elongation, and tortuosity of the cerebral arteries. It most frequently involves the vertebrobasilar arteries and carotid arteries, whereas a more peripheral location involving the anterior and the middle cerebral arteries (MCAs) is less frequent. We present a male patient with MCA dolichoectasia with radiologic follow-up for 3 years, and no ischemia or intracranial bleeding occurred after the antiplatelet therapy. From the reported case series of MCA dolichoectasia, we suggest that surgical procedure should not be adopted unless accompanied by aneurysm located at dolichoectatic MCA. Moreover, anticoagulation or antiplatelet therapy could be a good treatment of option to prevent ischemic events.

Middle cerebral artery dolichoectasia in a young woman with a previous stroke

We observed a 32-year-old female who had suffered from a left hemisphere ischemic stroke with right hemiparesis at the age of seven. At that time, a CT scan demonstrated a left ischemic lesion in nucleo-capsular region and a cerebral angiogram documented a complete occlusion of the supraclinoid segment of the internal carotid artery. When we observed the patient neurological examination demonstrated a moderate right brachio-crural hemiparesis. A brain MRI showed an old ischemic lesion involving the left nucleo-capsular and 'flow voids' suggestive for a vascular malformation in the left sylvian region. A cerebral rotational angiogram with 3-D reconstructions demonstrated a dolichoectatic left middle cerebral artery with an unusual 'corkscrew' aspect. Middle cerebral artery dolichoectasia is a rare pathological condition that may manifest with a stroke. The patients with intracranial arterial dolichoectasia (IADE) are most often hypertensive elderly men, and, to the best of our knowledge, an ischemic stroke associated with IADE has never been reported in children.