Ischemic stroke in young age due to dissection of intracranial carotid artery and its branches (clinical and morphological study)

We present clinical and morphological study of intracranial dissection of carotid artery and its branches led to massive brain infarct in practically health 23-year old female patient. Clinical picture was presented with sudden development of right sided hemiplegia, aphasia and left sided headache. Magnetic resonance image and ultrasound study showed increasing occlusion of the left intracranial internal carotid artery (ICA), middle (MCA) and anterior cerebral artery (ACA). On 11 day of disease lethal exit occurred. Autopsy study showed that the lumen of ICA, ACA and MCA was filled with a dense dark-red mass suggested to be intra-arterial thrombi. However microscopic study demonstrated that this mass was the hemorrhage in the arterial wall (intramural hematoma) which completely occluded its lumen. At the different levels of extraand intracranial arteries microscopy revealed pronounced dysplastic changes in the arterial wall (fibromuscular dysplasia), which were the main cause predisposed to arterial wall dissection and development of intramural hematoma. Presented observation demonstrates that dissection with intramural hematoma formation may be the cause of intracranial occlusion. On differential diagnosis with thrombosis one should take into consideration the absence of clinical and laboratory thrombophylic manifestations as well as atherosclerotic changes in cerebral arteries in patient with artery dissec- tion.