# Acute Cerebral Infarction Secondary to Spontaneous Isolated Middle Cerebral Artery Dissection: A Case Report

## TL;DR

A rare case of brain artery dissection causing a stroke is reported, highlighting the importance of considering this condition in sudden neurological events.

## Contribution

This case report presents a rare instance of spontaneous isolated middle cerebral artery dissection leading to acute stroke.

## Key findings

- A 64-year-old man presented with acute M1 occlusion due to spontaneous isolated middle cerebral artery dissection.
- Mechanical thrombectomy and angioplasty resulted in incomplete recanalization with residual stenosis.
- Headache at onset may indicate middle cerebral artery dissection, emphasizing the need for careful clinical and imaging assessment.

## Abstract

Spontaneous isolated middle cerebral artery dissection (MCAD) is uncommon. We report a rare case of acute M1 occlusion resulting from spontaneous isolated MCAD. A 64-year-old man was admitted to our hospital with an abrupt onset of headache, left hemiparesis, and sensory disturbances. Magnetic resonance imaging revealed a cerebral infarction in the right hemisphere, and magnetic resonance angiography confirmed right M1 occlusion. The patient underwent mechanical thrombectomy and percutaneous transluminal angioplasty, achieving incomplete recanalization with residual stenosis. Retrospective analysis of angiography after the initial pass revealed findings suggestive of MCAD, indicating spontaneous isolated dissection. Reports of mechanical thrombectomy in patients with complete occlusion due to spontaneous isolated MCAD are limited, and the optimal treatment strategy remains unclear. Although diagnosing this rare condition is challenging, the presence of headache at onset may indicate MCAD. This case highlights the importance of considering spontaneous isolated MCAD as a possible cause of acute M1 occlusion and underscores the need for careful assessment of clinical history and imaging findings.