• Ying Li, Feng Gao, Wei Sun, Zhaoxia Wang, and Haiqiang Jin.
• Department of Neurology, Peking University First Hospital, Beijing, China.
• Medicine (Baltimore). 2021 Dec 23; 100 (51): e28263e28263.

RationaleCerebral large artery occlusion in chronic central nervous system graft-versus-host disease after allogeneic hematopoietic stem cell transplantation (allo-HSCT) was very scarce. We described a young patient with bilateral white matter lesions and symptomatic internal carotid artery occlusion after allo-HSCT with the history of aplastic anemia.Patient ConcernsA 17-year-old girl with the history of aplastic anemia developed recurrent headache and sudden hemiplegia of right limbs 2 years after allo-HSCT.DiagnosesShe was diagnosed with skin chronic graft-versus-host disease 19 months after allo-HSCT. Brain magnetic resonance imaging showed bilateral subcortical white matter abnormal signals and hyperintensity of left fronto-parietal lobe on diffusion weighted imaging and corresponding hypointense apparent diffusion coefficients indicating acute infarction. CT angiography revealed thrombosis in left internal carotid artery. Carotid plaque high-resolution magnetic resonance imaging showed annular enhancement of vascular wall revealing signs of vasculitis.InterventionsIntravenous immunoglobulin, methylprednisolone, and anticoagulant therapy were used to treat the patient.OutcomesThe patient's symptoms gradually resolved and she could walk with assistance after 3 weeks before returned home.LessonsChronic graft-versus-host disease-associated vasculitis could involve cerebral large vessels which warrants further study.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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