Abstract
Case report: A 37-year-old man was admitted for a right MCA transient ischaemic attack. He was smoker, obese, dyslipidaemic, with previous history of heroin addiction and cured B and C hepatitis virus infections. Brain magnetic resonance and cardiac evaluation were normal. Transcranial color-coded sonography (TCCS) showed >50% proximal right MCA stenosis and distal left MCA occlusion. Treatment with aspirin and statin was started. Three months later, TCCS revealed >70% right MCA stenosis and left MCA occlusion. Selective angiography confirmed the steno-occlusive disease. Cerebrospinal fluid analysis revealed increased protein levels and a normal cell count. Corticotherapy was started, but the patient did not complied. Bilateral occlusion of MCA was noticed on TCCS, one month later, being the patient asymptomatic. Pulsed arterial spin labelling (PASL) revealed a severe decrease of cerebral blood flow in the distal part of both MCA territories.
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