Noninflammatory Cerebral Vasculopathy Associated with Recurrent Ischemic Strokes

Recurrent ischemic strokes often have uncommon causes in young adults. Vascular abnormalities may be considered as a possible etiology. We report a 36-year-old man who experienced recurrent cryptogenic ischemic strokes despite medical therapy. Conventional cerebral angiography was unrevealing. Subsequent brain biopsy revealed a distinctive histopathological pattern of abnormal perivascular collagen deposition without inflammation. Recurrent cryptogenic strokes may have novel etiologies, and brain biopsy should be considered when standard diagnostic tests fail.