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Tsuchiya A, Tsukiyama A, Matsumoto S, Uekusa T, Abe H, Fukui I, Iida Y, Mori K, Kawahara Y, Tamase A, Abe K, Yamashita R, Takeda M, Nakano T, Nomura M. Cerebral Infarction Due to Occlusion of Main Trunk of Middle Cerebral Artery in Patient with Accessory Middle Cerebral Artery. Asian J Neurosurg 2022; 17:495-499. [PMID: 36398188 PMCID: PMC9665973 DOI: 10.1055/s-0042-1757215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The existence of an accessory middle cerebral artery (AMCA) usually has no pathological significance. Three patients developed cerebral infarction due to thromboembolic occlusion of the main trunk of the middle cerebral artery (MCA). In these patients, AMCA originating from the anterior cerebral artery was intact, and ran to the lateral side along the main MCA. Emergency endovascular treatment to remove the thrombus in the main MCA was performed, and MCA was recanalized. In one patient, the main MCA re-occluded and cerebral infarction developed on the next day. The diameter of AMCA is commonly smaller than that of the main MCA. Therefore, volume of ischemic region depends on the collateral blood flow to the left MCA territory by AMCA. Once an anomalous MCA is detected in a patient with cerebral infarction involving the MCA territory, close examinations to assess the anatomy of both the main and anomalous MCA are mandatory.
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Affiliation(s)
| | | | | | | | - Hiroyuki Abe
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Issei Fukui
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yu Iida
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Kentaro Mori
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yosuke Kawahara
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Akira Tamase
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Katsuya Abe
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Ryotaro Yamashita
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Mutsuki Takeda
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Tatsu Nakano
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Motohiro Nomura
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan,Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan,Address for correspondence Motohiro Nomura, MD, PhD Department of Neurosurgery, Yokohama Sakae Kyosai Hospital132 Katsura-cho, Sakae-ku, Yokohama, 247-8581Japan
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Cooke J, Maingard J, Chandra RV, Slater LA, Brooks M, Asadi H. Acute middle cerebral artery stroke in a patient with a patent middle cerebral artery. Neurol Clin Pract 2019; 9:250-255. [PMID: 31341713 DOI: 10.1212/cpj.0000000000000605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/17/2018] [Indexed: 11/15/2022]
Abstract
Purpose of review Knowledge of cerebrovascular anatomical variants is vital for clinicians working with patients presenting with signs and symptoms of cerebral infarction, particularly in the era of endovascular clot retrieval. Recent findings We provide an overview of a cerebrovascular anatomical variation and detail a patient presenting with cerebral infarction secondary to occlusion of their anomalous vessel who underwent successful endovascular clot retrieval with excellent functional outcome. We also include technical descriptions. Summary Given the clinical importance of the areas supplied by the accessory middle cerebral artery, knowledge of this vessel is not only important for diagnosis but also for neurosurgical or endovascular management of patients with this variant.
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Affiliation(s)
- Jamie Cooke
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Julian Maingard
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ronil V Chandra
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lee-Anne Slater
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Mark Brooks
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Hamed Asadi
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
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Khrlobyan M, Olivas E, Feng L, Czar Taon M, Sangha N. Severe left MCA syndrome with an occluded accessory MCA. Neurol Clin Pract 2019; 9:279-281. [PMID: 31341719 DOI: 10.1212/cpj.0000000000000619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/04/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Manya Khrlobyan
- Department of Neurology (MK, EO, NS), Department of Neuro-Interventional Radiology (LF), and Department of Radiology (MCT), Kaiser Permanente, Los Angeles Medical Center, CA
| | - Edgar Olivas
- Department of Neurology (MK, EO, NS), Department of Neuro-Interventional Radiology (LF), and Department of Radiology (MCT), Kaiser Permanente, Los Angeles Medical Center, CA
| | - Lei Feng
- Department of Neurology (MK, EO, NS), Department of Neuro-Interventional Radiology (LF), and Department of Radiology (MCT), Kaiser Permanente, Los Angeles Medical Center, CA
| | - Matthew Czar Taon
- Department of Neurology (MK, EO, NS), Department of Neuro-Interventional Radiology (LF), and Department of Radiology (MCT), Kaiser Permanente, Los Angeles Medical Center, CA
| | - Navdeep Sangha
- Department of Neurology (MK, EO, NS), Department of Neuro-Interventional Radiology (LF), and Department of Radiology (MCT), Kaiser Permanente, Los Angeles Medical Center, CA
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Li K, Guo Y, Qu L, Xu B, Xu K, Yu J. Hybrid surgery for an arteriovenous malformation fed by an accessory middle cerebral artery and drained by a developmental venous anomaly: A case report and literature review. Exp Ther Med 2018; 16:1994-2000. [PMID: 30186430 PMCID: PMC6122327 DOI: 10.3892/etm.2018.6372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/21/2018] [Indexed: 11/05/2022] Open
Abstract
An accessory middle cerebral artery (AMCA), which mainly acts in the collateral circulation of the middle cerebral artery (MCA), is a rare anatomic malformation. Similar to other intracranial vessels, cerebrovascular disease can occur in the AMCA. However, the development of an arteriovenous malformation (AVM) in the AMCA is very rare, especially in conjuction with developmental venous anomalies (DVAs). Here, a rare case of an AMCA combined with an AVM and a DVA was reported. The patient was a 47-year-old female with intracranial hemorrhage at symptom onset. CT and MRI showed lesions in the left Sylvian fissure and insula accompanied by hemorrhage. DSA suggested a left AMCA; an AVM of the AMCA was located in the deep Sylvian fissure. The AVM was diffusely developed and drained into the DVA. The operation was performed in a hybrid operating room. The major feeding artery of the AVM, which was derived from the AMCA, was clipped, then the AVM and DVA were subsequently removed. Intraoperative DSA showed that the AVM and DVA were radically removed. A pathological examination confirmed the presence of an AVM. The patient recovered well and was discharged. Therefore, as highlighted in this case report, rare AVMs can be found in AMCAs and can even occur simultaneously with a DVA. Hybrid surgical treatment can be used to remove AVMs and can lead to an improved prognosis.
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Affiliation(s)
- Kailing Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Limei Qu
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Liu ZS, Zhou LJ, Sun Y, Kuang XW, Wang W, Li C. Sufficient collateral blood supply from accessory middle cerebral artery in a patient with acute ischemic stroke. Interv Neuroradiol 2015; 21:215-7. [PMID: 25943843 DOI: 10.1177/1591019915583230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We reported a case of acute embolic occlusion of the middle cerebral artery with a patent accessory middle cerebral artery. Because of the presence of sufficient collateral blood supply from the accessory middle cerebral artery, the patient only underwent transient ischemic attack and did not need endovascular treatment. There was mild infarction in the basal ganglia and temporal lobe, NIHSS score of the patient at discharge seven days after stroke onset was 0, and modified Rankin scale score at 90 days was 0.
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Affiliation(s)
- Zhen-Sheng Liu
- Department of Radiology, People's Hospital, Affiliated Hospital of Southeast University, Yangzhou, China
| | - Long-Jiang Zhou
- Department of Radiology, People's Hospital, Affiliated Hospital of Southeast University, Yangzhou, China
| | - Yong Sun
- Department of Radiology, People's Hospital, Affiliated Hospital of Southeast University, Yangzhou, China
| | - Xiong-Wei Kuang
- Department of Radiology, People's Hospital, Affiliated Hospital of Southeast University, Yangzhou, China
| | - Wei Wang
- Department of Radiology, People's Hospital, Affiliated Hospital of Southeast University, Yangzhou, China
| | - Cheng Li
- Department of Radiology, People's Hospital, Affiliated Hospital of Southeast University, Yangzhou, China
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