Dissection of the middle cerebral artery caused by invasion of malignant glioma presenting as acute onset of hemiplegia

A 57-year-old, previously healthy man who developed acute onset of hemipleg ia is presented. Neuro-imaging studies on admission suggested dissection of the middle cerebral artery producing infarction in the frontotemporal regi on. In contrast to his stable clinical course, serial neuro-imaging studies disclosed rapid growth of malignant glioma, which was confirmed at surgery . Microscopic examination of the surgical specimen demonstrated invasion of glioma cells into the arterial wall associated with intramural haematoma f ormation of the middle cerebral artery. This case is the first to document dissection of an intracranial artery caused by invasion of tumour cells.