# Acute spasticity in malignant MCA stroke: a case report and review of literature

## TL;DR

A rare case of a stroke patient showing acute spasticity at presentation highlights unusual stroke symptoms and potential steroid-related risk.

## Contribution

This case report adds a unique clinical observation of acute spasticity in malignant MCA stroke and suggests a possible link to anabolic steroid use.

## Key findings

- A 40-year-old male presented with acute spasticity, aphasia, and decreased consciousness due to left MCA occlusion.
- The patient required decompressive hemicraniectomy due to rapid cerebral edema progression.
- The case suggests anabolic steroids may contribute to stroke risk and atypical presentations.

## Abstract

Malignant Middle cerebral artery (MCA) infarction is characterized by rapid neurological deterioration due to cerebral edema. Spasticity, a common sequela of stroke, typically occurs days to weeks after the initial event. However, an acute onset of spasticity at presentation is extremely rare. We report a case of a 40-year-old male patient who presented with spasticity accompanied by aphasia and decreased consciousness. Left MCA occlusion was demonstrated on Computed tomography (CT) angiography. Cerebral edema developed rapidly, requiring decompressive hemicraniectomy (DH). The patient was a known smoker with androgenic anabolic steroid use. This case represents a rare presentation of malignant MCA infarction with acute spasticity and adds a unique aspect to the clinical spectrum of stroke presentation. This case emphasizes the need for awareness of atypical stroke presentation and the potential role of anabolic steroids in stroke risk.