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A 16-year-old female was admitted to hospital due to intermittent right-sided headaches. On admission, physical and neurological examinations yielded no unusual findings. She underwent a MRI and angiography (MRI-MRA) (fig 1A–C) that showed a fusiform dilatation of the right middle cerebral artery (MCA) division branches. A subsequent plain CT scan of the head and a lumbar puncture revealed no subarachnoid bleeding. Two weeks later, catheter angiography (DSA) showed a stenosis-dilatation-stenosis pattern (pearl-and-string sign) of the lower division branch of the right MCA, consistent with dissection (fig 1D). To exclude a mycotic or infective …
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