title: Isolated MCA disease in patients without significant atherosclerotic risk factors: a high-resolution magnetic resonance imaging study.
abstract: OBJECTIVE
  Diagnosis of intracranial artery atherosclerosis remains often uncertain. The high-resolution magnetic resonance imaging (HR-MRI) enables vessel wall assessment for more precise diagnoses. The aim of the present study was to investigate the etiologies of middle cerebral artery steno-occlusive disease in young adult patients with few atherosclerotic risk factors using HR-MRI.
  
  
  METHODS
  We prospectively studied patients who visited a tertiary hospital in Seoul, Korea, and had (1) unilateral middle cerebral artery disease (≥50% stenosis or occlusion), (2) were ≤55 years old and had no or minimal (≤1) atherosclerotic risk factors. We excluded patients with a confirmed diagnosis of Moyamoya disease, vasculitis, or dissection and those having emboligenic sources. A presumptive diagnosis was made based on HR-MRI findings, and patients were categorized as HR-athero (atherosclerotic disease), HR-MMD (Moyamoya disease), HR-dissection, or HR-vasculitis.
  
  
  RESULTS
  Among 95 patients analyzed, 26 (27.4%) had HR-athero who were more often male (P=0.004), smokers (P=0.018), and had focal stenosis (P=0.003) than others.As compared with the HR-athero patients, 29 HR-MMD patients were more often female (P<0.001) and more often had occlusive lesions (P=0.001) and nonfocal stenosis (P<0.001). The 22 HR-dissection patients tended to have hypertension less often, and the 13 HR-vasculitis patients were younger (P=0.004) and tended to have nonfocal stenosis. [corrected].
  
  
  CONCLUSIONS
  In our cohort of young patients with minimal risk factors, atherosclerosis seems to be an uncommon pathology of middle cerebral artery stenosis. HR-MRI aids us to make a more reliable diagnosis.
authors: From the Department of Neurology (S.-H.A., J.L., Y.-J.K., S.U.K., D.-W.K., J.S.K.) and Neuroradiology (D.L., S.-C.J.), University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors: Sung-Ho
authors: SH
authors: Ahn
authors: From the Department of Neurology (S.-H.A., J.L., Y.-J.K., S.U.K., D.-W.K., J.S.K.) and Neuroradiology (D.L., S.-C.J.), University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors: Jookyung
authors: J
authors: Lee
authors: From the Department of Neurology (S.-H.A., J.L., Y.-J.K., S.U.K., D.-W.K., J.S.K.) and Neuroradiology (D.L., S.-C.J.), University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors: Yeon-Jung
authors: YJ
authors: Kim
authors: From the Department of Neurology (S.-H.A., J.L., Y.-J.K., S.U.K., D.-W.K., J.S.K.) and Neuroradiology (D.L., S.-C.J.), University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors: Sun U
authors: SU
authors: Kwon
authors: From the Department of Neurology (S.-H.A., J.L., Y.-J.K., S.U.K., D.-W.K., J.S.K.) and Neuroradiology (D.L., S.-C.J.), University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors: Deokhee
authors: D
authors: Lee
authors: From the Department of Neurology (S.-H.A., J.L., Y.-J.K., S.U.K., D.-W.K., J.S.K.) and Neuroradiology (D.L., S.-C.J.), University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors: Seung-Chai
authors: SC
authors: Jung
authors: From the Department of Neurology (S.-H.A., J.L., Y.-J.K., S.U.K., D.-W.K., J.S.K.) and Neuroradiology (D.L., S.-C.J.), University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors: Dong-Wha
authors: DW
authors: Kang
authors: From the Department of Neurology (S.-H.A., J.L., Y.-J.K., S.U.K., D.-W.K., J.S.K.) and Neuroradiology (D.L., S.-C.J.), University of Ulsan, Asan Medical Center, Seoul, South Korea. jongskim@amc.seoul.kr.
authors: Jong S
authors: JS
authors: Kim
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D003251:Constriction, Pathologic / Q000503:physiopathology; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology*; D011446:Prospective Studies; D056910:Republic of Korea; D012307:Risk Factors; D012907:Smoking; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Moyamoya disease; atherosclerosis; dissection; middle cerebral artery