Multiple Progressive Intracranial Arterial Occlusions

A 30-year-old woman experienced a series of strokes over a period of three months. Radiographical studies showed evidence of occlusive disease of the cerebral arteries and a rich collateral circulation typical of multiple progressive intracranial arterial occlusive disease. At autopsy, the involved cerebral arteries showed marked fibrosis of the intima, media and adventitia, degeneration of the internal elastic lamina, and evidence of old and recent thrombosis. These findings are interpreted as a late stage of the disease and give no indication as to its pathogenesis. It is suggested that the vascular disease may have had its onset in childhood with the terminal strokes related to institution of oral contraceptive therapy.