Background: Subcortical transient ischemic attacks are usually seen in individuals with small-vessel disease. They are often refractory to medical treatment and progress to infarction in many cases.
Patient: We describe a young man with an unusual and protracted case of recurrent capsular ischemia due to postcoital middle cerebral artery dissection.
Conclusion: Spontaneous middle cerebral artery dissection should be considered in young patients presenting with subcortical transient ischemic attacks.