Abstract Details

Title Spontaneous Proximal Middle Cerebral Artery Dissection due to Stimulant-associated Vascular Injury

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-006

Objective N/A

Background Intracranial arterial dissection (IAD) is an uncommon cause of ischemic stroke in young adults, with middle cerebral artery (MCA) involvement particularly rare. Management strategies remain non-standardized and are often extrapolated from cervical dissection data. We report a case of spontaneous MCA dissection in a 28-year-old woman.

Design/Methods N/A

Results A 28-year-old woman with history of generalized anxiety disorder and ADHD presented with acute aphasia, left gaze deviation, and dense right hemiparesis. CT angiography demonstrated left M1 occlusion. Given the severity of her deficits, she received IV Tenecteplase and was transferred for thrombectomy.

Digital subtraction angiography confirmed left M1 occlusion with underlying proximal MCA dissection. In addition to thrombectomy, stent-assisted reconstruction was performed, with a stent deployed from the superior M2 branch into the proximal M1. She was treated with IV eptifibatide and transitioned to aspirin 81 mg daily.

Follow-up MRI/MRA showed a large left MCA infarction with persistent left M1 occlusion. Her course was complicated by stent re-occlusion and malignant cerebral edema requiring hemicraniectomy.

A thorough evaluation for vascular, infectious, autoimmune, hematologic, malignant, cardiac, and genetic etiologies was unrevealing apart from a small patent foramen ovale. No distal venous thrombosis was identified on ultrasound. She was discharged to rehabilitation with significant deficits on aspirin and high-intensity statin therapy. Given her use of bupropion and Adderall, stimulant-associated vascular injury was considered.

Conclusions

Intracranial arterial dissection (IAD) is a rare cause of stroke in the young that frequently requires angiography for diagnosis. Management remains unstandardized and necessitates broad differential consideration for underlying etiology. In our unique case, a potential cause may have been stimulant-associated vascular injury, as amphetamine derivatives have been linked to vasculopathy, vasospasm, and vessel wall injury. This case highlights IAD as a rare but important cause of stroke in the young and raises stimulant-associated vascular injury as a possible contributor.

Authors/Disclosures
Katherine Sinchek, MD (Rush University Medical Center) PRESENTER	Dr. Sinchek has nothing to disclose.
Eliot England	Ms. England has nothing to disclose.
Zain Ashary, MD (Rush University Medical Center)	An immediate family member of Dr. Ashary has received personal compensation for serving as an employee of AbbVie.

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