Localized scleroderma associated with progressing ischemic stroke

We present a 73 year-old Japanese woman with localized scleroderma involvin g the right side of the scalp accompanied by continuous tingling pain, who developed insidiously progressive left hemiparesis. In magnetic resonance i maging of the brain, an infarct first appeared in the watershed region of t he right middle cerebral artery territory and subsequently extended to deep white matter accompanied by scattered hemorrhages. Focal stenosis in the M 2 portion of the right middle cerebral artery was revealed on magnetic reso nance angiography, and the distal vessels were only shown faintly. A biopsy specimen from the sclerotic scalp lesion showed obvious thickening of vess el walls and mild mononuclear cell infiltration. We believe that the progre ssing ischemic stroke was caused by hemodynamic disturbances from localized sclerotic obstruction of the middle cerebral artery, with an autoimmune pa thogenesis. (C) 1999 Published by Elsevier Science B.V. All rights reserved .