The case of a 33-year old woman with recurrent cerebral and peripheral ischaemic attacks is reported and the difficult nosological problem of juvenile ischaemia is discussed. Thromboangiitis obliterans (Buerger's disease) was excluded by morphological studies of finger tips, temporal artery and dermis, which demonstrated arteriolar dysplasia and premature aging of the connective tissue. A diagnosis of "juvenile atheroma" may be considered in view of the dyslipidaemia and increase in skin cholesterol and apoprotein B concentrations observed. A review of the literature, together with the biochemical and histological findings in this patient, suggests that ischaemic attacks, dysplasia of small vessels and serum dyslipidaemia reflected in the dermis are all manifestations of early atheroma.