Acute Left Middle Cerebral Artery Perforator Territory Infarction in a Patient with Bilateral Middle Cerebral Artery Vasculopathy and a Rare COL4A2 c.941del Variant

We report a 25-year-old man with acute left middle cerebral artery perforator territory infarction, bilateral middle cerebral artery stenoses, right M1 vessel-wall enhancement suggesting non-atherosclerotic vasculopathy, and a rare heterozygous COL4A2 c.941del frameshift variant, highlighting the need to consider <i>COL4A1/A2</i>-related vasculopathy in young stroke patients with atypical bilateral intracranial arterial abnormalities.