An uncommon cause of stroke in young adults

We describe a previously healthy 48-year-old man who presented with clinica l characteristics suggestive of internal carotid artery dissection, confirm ed by magnetic resonance imaging. He developed a massive infarction of the left cerebral hemisphere and died after 3 days of transtentorial herniation . Postmortem examination identified a dissection of the thoracic aorta caus ed by Erdheim-Gsell cystic medionecrosis, with the characteristic degenerat ion of the elastic fibers of the lamina media. The dissection showed an unu sually large extension not only distally into both iliac arteries, but also proximally into both carotid arteries. To our knowledge, such an extensive dissection has not been described previously. Underlying vessel wall disor ders of the aorta, such as Erdheim Gsell cystic medionecrosis, should be co nsidered in young patients with spontaneous arterial dissection.