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Zedde M, Moratti C, Pavone C, Napoli M, Valzania F, Nguyen TN, Abdalkader M, Pascarella R. Twig-like Middle Cerebral Artery: Case Series in a European Population. World Neurosurg 2024; 183:e11-e21. [PMID: 37806521 DOI: 10.1016/j.wneu.2023.09.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Twig-like middle cerebral artery (MCA) is a rare anomaly where the M1 MCA is partially or completely replaced by a plexiform network. It has been described in angiographic series from Asian and South-American cohorts, but has not yet been reported in a European population. METHODS The digital subtraction angiograms (DSAs) of adult patients referred to a single neurovascular center for a diagnostic hypothesis of moyamoya arteriopathy (MMA) from 2018 to 2023 were prospectively and retrospectively checked by experienced neuroradiologists for identifying patients with twig-like MCA. The angioarchitecture of twig-like MCA was systematically evaluated and described. RESULTS Five of 30 (16.7%) male patients (mean age 55.8 + 14.7 years) of European ancestry were identified as having twig-like MCA. The clinical presentations were ischemic stroke (2 of 5), hemorrhagic stroke (1 of 5), and headache (2 of 5). All patients showed a unilateral involvement on DSA and in 1 of 5 (20%) an intracranial aneurysm was found. DSA was used to confirm the diagnosis of twig-like MCA and define the angioarchitecture and associated anomalies. An accessory MCA and recurrent artery of Heubner were found in 3 of 5 (60%) cases, feeding the network together with the anterior choroidal artery (4 of 5, 80%). CONCLUSIONS Twig-like MCA is a rare vascular anomaly, but it seems to be less rare than expected among adult European patients with suspected MMA on noninvasive neuroimaging studies. DSA is fundamental for a reliable differential diagnosis and should not be omitted in these patients.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy.
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Claudio Pavone
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Thanh N Nguyen
- Departments of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
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Kashtiara A, Beldé S, Schollaert J, Menovsky T. Anatomical Variations and Anomalies of the Middle Cerebral Artery. World Neurosurg 2024; 183:e187-e200. [PMID: 38101539 DOI: 10.1016/j.wneu.2023.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Intracranial arteries have a high rate of variation, but a clear schematic overview is lacking. In this pictorial review we classify and depict all the variations and anomalies within the middle cerebral artery (MCA). METHODS PubMed was searched with the MeSH-term "Middle Cerebral Artery." Articles were selected based on their description of variants within the MCA. Cross-referencing was used to broaden the range of articles. The anatomical variants were then schematically drawn using the anteroposterior and lateral view during angiography of the internal carotid artery. RESULTS A total of 29 unique medical illustrations were made, depicting variation in number of vessels; variation in vessel origin; and variation in morphology. CONCLUSIONS The MCA provides vital blood supply to the frontal, parietal, temporal, and central brain structures. An overview of these variations is important to diagnose and treat patients with MCA-related pathology correctly and safely. They can aid in distinguishing pathology from normal anatomical variance; aid neurosurgeons during aneurysmal clipping or arteriovenous malformation resections; and aid interventional radiologists during thrombectomy or coiling. This article provides a summary regarding current knowledge of anatomical variations within the MCA, their prevalence and clinical relevance. A total of 29 unique illustrations were made, depicting currently known variants. We encourage all who diagnose, treat, and study the MCA to use this overview for a uniform and better understanding of its anatomy.
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Affiliation(s)
- Ardavan Kashtiara
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium.
| | - Sarah Beldé
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Joris Schollaert
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Kawakami M, Murai S, Kusaka N, Baba F, Inoue Y, Miyake H, Shinji Y, Itami H, Otsuka S, Nishiura T, Ogihara K. Non-aneurysmal subarachnoid hemorrhage in aplastic or twig-like middle cerebral artery: A case report and literature review. J Stroke Cerebrovasc Dis 2024; 33:107582. [PMID: 38237811 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare vascular anomaly that can cause hemorrhagic and ischemic stroke. Ap/T-MCA can induce aneurysms due to the fragility of the vessel wall, consequently leading to subarachnoid hemorrhage. Herein, we report a case of Ap/T-MCA with subarachnoid hemorrhage without an aneurysm. CASE PRESENTATION A 67-year-old man presented to our hospital with a sudden onset of headache. Computed tomography of the head revealed subarachnoid hemorrhage (SAH) in the left Sylvian fissure; however, no aneurysm was observed on digital subtraction angiography. Following conservative treatment, follow-up imaging showed no aneurysm or no recurrent stroke. CONCLUSION Non-aneurysmal SAH is a possible indication of vessel wall fragility in Ap/T-MCA; however, a standardized treatment strategy for this condition remains to be established.
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Affiliation(s)
- Masato Kawakami
- Department of Neurological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences.
| | | | - Noboru Kusaka
- Department of Neurological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Fukiko Baba
- Department of Neurosurgery, Iwakuni Clinical Center.
| | - Yohei Inoue
- Department of Neurological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hayato Miyake
- Department of Neurological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences.
| | - Yukei Shinji
- Department of Neurosurgery, Japanese Red Cross Society Himeji Hospital
| | | | - Shinji Otsuka
- Department of Neurosurgery, Iwakuni Clinical Center.
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Colombo E, Brinjikji W, Klaas J, Lanzino G. Teaching NeuroImages: Rete-like middle cerebral artery. Neurology 2019; 93:e1919-e1920. [PMID: 31712382 DOI: 10.1212/wnl.0000000000008480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- Elisa Colombo
- From the Departments of Neurosurgery (E.C.), Radiology (W.B.), and Neurology (J.K., G.L.), Mayo Clinic, Rochester, MN
| | - Waleed Brinjikji
- From the Departments of Neurosurgery (E.C.), Radiology (W.B.), and Neurology (J.K., G.L.), Mayo Clinic, Rochester, MN
| | - James Klaas
- From the Departments of Neurosurgery (E.C.), Radiology (W.B.), and Neurology (J.K., G.L.), Mayo Clinic, Rochester, MN
| | - Giuseppe Lanzino
- From the Departments of Neurosurgery (E.C.), Radiology (W.B.), and Neurology (J.K., G.L.), Mayo Clinic, Rochester, MN.
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Runde D. Calculated Decisions: Alberta Stroke Program Early CT Score (ASPECTS). Emerg Med Pract 2019; 21:CD6-CD7. [PMID: 31294947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/15/2019] [Indexed: 06/09/2023]
Abstract
The Alberta Stroke Program Early CT Score (ASPECTS) assesses the severity of middle cerebral artery stroke using available computed tomography data.
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Affiliation(s)
- Daniel Runde
- Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
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Sturm D, Froese G, Haupt C, Kitzrow M. [Twig-like middle cerebral artery-a rare anomaly of intracranial vessels]. Nervenarzt 2019; 90:616-617. [PMID: 31041465 DOI: 10.1007/s00115-019-0722-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Dietrich Sturm
- Klinik für Neurologie, Agaplesion Bethesda - Krankenhaus, Hainstr. 35, 42109, Wuppertal, Deutschland.
| | - Gerhard Froese
- Klinik für Radiologie und Neuroradiologie, Agaplesion Bethesda - Krankenhaus, Wuppertal, Deutschland
| | - Cornel Haupt
- Klinik für Radiologie und Neuroradiologie, Agaplesion Bethesda - Krankenhaus, Wuppertal, Deutschland
| | - Martin Kitzrow
- Klinik für Neurologie, Agaplesion Bethesda - Krankenhaus, Hainstr. 35, 42109, Wuppertal, Deutschland
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Abstract
RATIONALE Middle cerebral artery (MCA) anomalies are relatively rare and often related to aneurysms. Familiarity with these anomalies is important in resolving problems that arise in the complex angioarchitecture. Reports often describe that aneurysms that are related to accessory or duplicated MCA are often located at its origin. PATIENT CONCERNS A 59-year-old man presented with a headache for 10 days, without nausea and vomiting. The physical examination was negative. DIAGNOSIS A computed tomography (CT) scan revealed an intracerebral hematoma in the deep right frontal lobe, near the caudate nucleus. Digital subtraction angiography (DSA) revealed an anomalous duplicated origin of the right MCA, with occlusion of the main MCA trunk as well as twisting and dilation of the accessory MCA trunk. A wide-necked aneurysm was located at a sharp curve of the tortuous accessory MCA trunk. A ruptured aneurysm related to a duplicated MCA origin was diagnosed. INTERVENTIONS Open surgery was rejected by the patient; hence, palliative endovascular coil embolization of the larger daughter sac was performed. OUTCOMES The postoperative course was uneventful. There was no rebleeding at 8-months follow-up. LESSONS MCA anomalies are relatively rare and often related to aneurysms. It is important to be familiar with these anomalies as related lesions often manifest within a complex angioarchitecture. Aneurysms at the trunk of an anomalous MCA are a rare entity and open surgery may be recommended.
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Takahashi M, Uchino A, Suzuki C. Anastomosis between accessory middle cerebral artery and middle cerebral artery diagnosed by magnetic resonance angiography. Surg Radiol Anat 2016; 39:685-687. [PMID: 27771760 DOI: 10.1007/s00276-016-1763-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022]
Abstract
The accessory middle cerebral artery (MCA) is a common variation of the MCA that arises from the anterior cerebral artery. We report a patient with anastomosis of the accessory MCA with the main MCA, an extremely rare variant that we diagnosed by magnetic resonance (MR) angiography. Both partial maximum-intensity-projection and partial volume-rendering MR angiographic images obtained at 3 T are useful to identify such rare vascular variation.
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Affiliation(s)
- Masao Takahashi
- Department of Diagnostic Radiology, Saitama Medial University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Akira Uchino
- Department of Diagnostic Radiology, Saitama Medial University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Chihiro Suzuki
- Neuroscience Center, Suzuki Neurosurgical Clinic, Kawagoe, Japan
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Gómez-Choco M, Nedelmann M, Valdueza JM. Stenosis in Middle Cerebral Artery Duplication: Assessment With Transcranial Color-Coded Duplex Sonography. J Ultrasound Med 2016; 35:2053-2056. [PMID: 27492393 DOI: 10.7863/ultra.15.11041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/21/2015] [Indexed: 06/06/2023]
Abstract
Duplication of the middle cerebral artery is an unusual anatomic variant. Stenosis of one of its branches can be an exceptional cause of stroke and is very difficult to diagnose with transcranial duplex sonography. We report 2 patients with duplication of the middle cerebral artery in whom stenosis of one of its branches led to ischemic stroke and describe the sonographic findings in comparison to other neuroimaging modalities. These cases highlight the utility of adding a coronal insonation plane on top of the traditional axial plane to avoid identification pitfalls in patients with anatomic variants.
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Affiliation(s)
| | - Max Nedelmann
- Department of Neurology, Sana Regio Klinikum, Pinneberg, Germany, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - José M Valdueza
- Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany
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Schwaiger BJ, Gersing AS, Zimmer C, Prothmann S. The Curved MCA: Influence of Vessel Anatomy on Recanalization Results of Mechanical Thrombectomy after Acute Ischemic Stroke. AJNR Am J Neuroradiol 2015; 36:971-6. [PMID: 25634721 DOI: 10.3174/ajnr.a4222] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/17/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vessel anatomy is assumed to influence results of endovascular mechanical thrombectomy using stent retrievers. The purpose of this study was to analyze the influence of vessel curvature on recanalization results in patients with acute ischemic stroke caused by large-vessel occlusion. MATERIALS AND METHODS In 159 patients (70 ± 12.8 years of age; 79 women) treated for acute ischemic stroke after carotid T and/or MCA occlusion by using stent retrievers, the following angles were measured in standard anteroposterior angiograms to describe vessel anatomy: first, between the terminal ICA segment and the most downward curved M1 segment conterminous to the proximal face of the thrombus (ICA/M1 angle); second, between the most proximal M1 segment and the segment immediately conterminous to the thrombus (M1/M1 angle); and additionally, in patients with distal M1/proximal M2 occlusion, the angle of the last curvature proximal of the thrombus (M1/M2 angle). Angles of patients with-versus-without successful recanalization were compared. RESULTS Patients without successful recanalization (TICI 0-2a) showed significantly larger ICA/M1 angles (mean, 110°± 23.8° versus 69°± 28.7°, P < .001) and significantly larger M1/M1 angles (56°± 29.2° versus 29°± 26.6°, P = .001) than patients with successful recanalization (TICI 2b/3). In patients without successful recanalization after a distal M1 or proximal M2 occlusion, the M1/M2 angle was significantly larger than that in patients with successful recanalization (117° ± 34.3° versus 67° ± 29.5°, P = .006). CONCLUSIONS This retrospective analysis showed that mechanical thrombectomy in the anterior circulation was significantly less often successful in patients with large vessel angles. Therefore, vessel curvature significantly influences the results of mechanical thrombectomy with stent retrievers for treatment of acute ischemic stroke. Further work is needed to understand the underlying causality.
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Affiliation(s)
- B J Schwaiger
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
| | - A S Gersing
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - C Zimmer
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - S Prothmann
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Rogge A, Doepp F, Schreiber S, Valdueza JM. Transcranial color-coded duplex sonography of the middle cerebral artery: more than just the M1 segment. J Ultrasound Med 2015; 34:267-273. [PMID: 25614400 DOI: 10.7863/ultra.34.2.267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Routine sonography of the middle cerebral artery in acute ischemic stroke usually focuses on the main stem (M1 segment). However, stenoses and occlusions affect not only proximal but also more distal vessel branches, such as the M2 segments. Transcranial color-coded duplex sonography allows visualization of these segments; however, a formal analysis and description of normal blood flow values are missing. The purpose of this study was to analyze middle cerebral artery branching patterns with transcranial color-coded duplex sonography and to establish reference flow velocity values in the detectable M2 branches as well as the early temporal M1 branch. METHODS Transcranial color-coded duplex sonography in the axial and coronal planes was performed in 50 participants without vascular disease and with a good temporal bone window (ie, fully visible M1 middle cerebral artery segment and A1 anterior cerebral artery segment). We analyzed the course and branching pattern of the M1 segment, including anatomic variants such as an early temporal M1 branch, and measured the length and flow parameters of the detectable M2 branches. RESULTS Assessment of 100 hemispheres allowed classification into 3 anatomic patterns: M1 bifurcation (63%), M1 trifurcation (32%), and medial M1 branching into 2 major segments (2%). A clear distinction was not possible in 3 cases (3%). An early temporal M1 branch was detected in the coronal plane in 26%. CONCLUSIONS Transcranial color-coded duplex sonography is a useful tool for analyzing anatomic variants and branching patterns of the middle cerebral artery as well as flow characteristics of M2 segments. Therefore, it also has potential to increase the diagnostic yield for the detection of middle cerebral artery disease in these vessel segments.
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Affiliation(s)
- Annette Rogge
- Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany (A.R., J.M.V.); Neurological Department, Charité Campus Virchow, Berlin, Germany (F.D.); and Neurological Department, Charité Campus Mitte, Berlin, Germany (S.S.).
| | - Florian Doepp
- Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany (A.R., J.M.V.); Neurological Department, Charité Campus Virchow, Berlin, Germany (F.D.); and Neurological Department, Charité Campus Mitte, Berlin, Germany (S.S.)
| | - Stephan Schreiber
- Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany (A.R., J.M.V.); Neurological Department, Charité Campus Virchow, Berlin, Germany (F.D.); and Neurological Department, Charité Campus Mitte, Berlin, Germany (S.S.)
| | - José Manuel Valdueza
- Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany (A.R., J.M.V.); Neurological Department, Charité Campus Virchow, Berlin, Germany (F.D.); and Neurological Department, Charité Campus Mitte, Berlin, Germany (S.S.)
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Abstract
We herein present two cases of cerebral infarction in the middle cerebral artery (MCA) territory associated with an accessory middle cerebral artery (AMCA), which is a rare anomalous vessel arising from the anterior cerebral artery that coexists with the main trunk of the MCA. Cerebral infarction occurred in both patients: due to occlusion of the MCA main trunk in one patient and occlusion of the AMCA in the other patient. These cases suggest the importance of recognizing an AMCA when interpreting neuroradiological findings in patients with MCA ischemic stroke, especially in the hyperacute phase.
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Affiliation(s)
- Yu Hiramatsu
- Department of Neurology, National Hospital Organization Kagoshima Medical Center, Japan
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OTANI N, WADA K, SAKAKIBARA F, TAKEUCHI S, NAGATANI K, KOBAYASHI H, OSADA H, SUZUKI T, MORI K. A ruptured aneurysm located at a collateral artery that extended from the proximal A2 segment to the M1 segment, associated with an anomalous branch of the anterior choroidal artery and middle cerebral artery hypoplasia: case report. Neurol Med Chir (Tokyo) 2013; 54:201-4. [PMID: 24140763 PMCID: PMC4533421 DOI: 10.2176/nmc.cr2012-0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 11/28/2012] [Indexed: 11/20/2022] Open
Abstract
We here describe the first case of a ruptured aneurysm located at a collateral artery that extended from the proximal A2 segment to the M1 segment, which was associated with an anomalous branch of the anterior choroidal artery and middle cerebral artery (MCA) hypoplasia. The aneurysm was revealed by angiograms and intraoperative findings. No previous accounts have been published of such an extremely rare vessel anomaly. In practice, this case highlights the urgent need to preoperatively recognize such vascular anomalies, as well as to better understand the collateral blood supply in cerebral ischemia associated with these MCA anomalies. Such knowledge will be helpful for planning optimal surgical procedures.
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Affiliation(s)
- Naoki OTANI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Kojiro WADA
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Fumihiro SAKAKIBARA
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Satoru TAKEUCHI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Kimihiro NAGATANI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Hiroaki KOBAYASHI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Hideo OSADA
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Takamoto SUZUKI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Kentaro MORI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
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Gómez-Choco M, Valdueza JM. Duplication of the middle cerebral artery: a potential pitfall for transcranial Doppler examination. J Ultrasound Med 2013; 32:1517-1519. [PMID: 23887966 DOI: 10.7863/ultra.32.8.1517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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15
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Bashir Q, Badruddin A, Arif S, Hersonsky T. Non-moyamoya bilateral middle cerebral artery agenesis mimicking multiple sclerosis. J Ayub Med Coll Abbottabad 2013; 25:215-216. [PMID: 25098101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present a case of a 41-year-old woman who carried the misdiagnosis of multiple sclerosis for 13 years while on disease modifying therapy [DMT]. Her neurologic work-up showed an extremely rare type of bilateral middle cerebral arteryocclusive disease, a basilar apex aneurysm and paroxysmal atrial fibrillation. A thorough search for alternative neurologic diagnosis is recommended before patients are given a definitive diagnosis and committed to DMT.
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LaBorde DV, Mason AM, Riley J, Dion JE, Barrow DL. Aneurysm of a duplicate middle cerebral artery. World Neurosurg 2011; 77:201.e1-4. [PMID: 22405396 DOI: 10.1016/j.wneu.2011.03.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 09/16/2010] [Accepted: 03/29/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anatomic middle cerebral artery (MCA) anomalies are rare, but each of the described variants (eg, duplicate, fenestrated, accessory) can be of clinical significance. CASE DESCRIPTION A 34-year-old man with a history of left hemispheric stroke was found to have an aberrant, early-arising duplicate left M1 segment of the MCA with an associated asymptomatic fusiform aneurysm. The patient was treated with a superficial temporal artery (STA) to distal MCA bypass followed by surgical trapping of the aneurysm. RESULTS Intraoperative and follow-up angiography performed postoperatively at 3 months showed complete isolation of the aneurysm from the circulation and patency of the bypass graft. The postoperative course was uneventful with the exception of a craniotomy flap infection, which was effectively managed with intravenous antibiotics, flap removal, and subsequent use of a fabricated replacement. CONCLUSIONS This rare case is presented and used as a framework for a brief discussion of the literature regarding both variant MCA anatomy and treatment considerations for these anomalies when associated with an aneurysm.
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Affiliation(s)
- David V LaBorde
- Department of Neurosurgery, Division of Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Wesley AJ, Thomas JT, Petersen S, Cincotta R, Lourie R, Gardener G. An Acardiac twin with a documented heart beat at 6 + 5 weeks and TRAP diagnosed at 8 + 5 weeks-insights into possible pathophysiology. Prenat Diagn 2011; 31:413-4. [PMID: 21302336 DOI: 10.1002/pd.2710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/10/2010] [Accepted: 12/20/2010] [Indexed: 11/07/2022]
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Miyahara K, Fujitsu K, Ichikawa T, Mukaihara S, Okada T, Kaku S. [Unruptured saccular aneurysm at the origin of the duplicated middle cerebral artery: reports of two cases and review of the literature]. No Shinkei Geka 2009; 37:1241-1245. [PMID: 19999558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report on two rare cases of unruptured saccular aneurysm located at the origin of the duplicated middle cerebral artery. Case 1: On magnetic resonance (MR) angiography, a 56-year-old woman was diagnosed as having an unruptured right middle cerebral artery (MCA) bifurcation aneurysm. Right carotid angiography disclosed a duplicated MCA and four unruptured saccular aneurysms, including the origin of the duplicated MCA. Case 2: A 58-year-old man had a sudden onset of vertigo, and underwent MR imaging. The MR angiography detected a right internal carotid artery (ICA) aneurysm, and the subsequent angiography demonstrated duplication of the right MCA and two intracranial aneurysms; one at the origin of the posterior communicating artery (PcomA), the other at the origin of the duplicated MCA. Each aneurysm was successfully clipped through the transsylvian approach. The postoperative courses were uneventful and both patients were discharged in good condition. There have been only 19 previous reports of the duplicated MCA aneurysm in the literature.
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Affiliation(s)
- Kosuke Miyahara
- Department of Neurosurgery, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-Ku, Yokohama-shi, Kanagawa 245-8575, Japan
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21
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Nussbaum ES, Defillo A, Janjua TM, Nussbaum LA. Fenestration of the middle cerebral artery with an associated ruptured aneurysm. J Clin Neurosci 2009; 16:845-7. [PMID: 19289288 DOI: 10.1016/j.jocn.2008.08.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 08/24/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Eric S Nussbaum
- HealthEast National Brain Aneurysm Center, St Joseph's Hospital, 69 West Exchange Street, St Paul, Minnesota 55102, USA.
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22
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Krnić N, Dumić K, Rados M, Putarek NR, Stanimirović A. [Duplication of the pituitary gland]. Lijec Vjesn 2009; 131:130-132. [PMID: 19642532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Duplication of the pituitary gland is a rare malformation. To the best of our knowledge, only 40 cases throughout the world have been reported previously. Due to associated severe developmental anomalies lots of these cases were diagnosed at autopsy. Only 7 patients survived beyond puberty, however, it is important to stress that none of them had major brain anomalies. We present the case of a girl with duplication of the pituitary gland (DPG), central precocious puberty and associated midline defects. Among fenestration of basilar artery, previously described in the literature, we also found, for the first time, a duplication of the M1-segment of the left median cerebral artery. Our patient is one of the 4 DPG patients with associated precocious puberty treated with gonadotropine releasing hormone agonists (GnRH), but the only one in whom this treatment was finished successfully.
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Affiliation(s)
- Nevena Krnić
- Klinika za pedijatriju Rebro, Medicinski fakultet i KBC Zagreb
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23
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Suyama K, Mizota S, Minagawa T, Hayashi K, Miyazaki H, Nagata I. A ruptured anterior communicating artery aneurysm associated with internal carotid artery agenesis and a middle cerebral artery anomaly. J Clin Neurosci 2009; 16:585-6. [PMID: 19200736 DOI: 10.1016/j.jocn.2008.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 05/28/2008] [Accepted: 06/01/2008] [Indexed: 10/21/2022]
Abstract
Agenesis of the internal carotid artery associated with an anomalous middle cerebral artery originating from the contralateral internal carotid artery is rare. We report a patient with agenesis of the internal carotid artery presented with a subarachnoid hemorrhage due to a rupture of an aneurysm in the anterior communicating artery.
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Affiliation(s)
- Kazuhiko Suyama
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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24
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R. [Abnormal origin of middle cerebral artery in the basilar artery]. Neurologia 2008; 23:536-537. [PMID: 19035000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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25
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Affiliation(s)
- T E Herman
- Department of Radiology, Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University, St Louis, MO 63110, USA.
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26
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Arslan EB, Oztürk A, Oğuz KK. Incidental bilateral accessory middle cerebral arteries on MR imaging and MR angiography. Diagn Interv Radiol 2007; 13:10-2. [PMID: 17354187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Intracranial vascular variations involving the middle cerebral artery are rarely seen. Herein, we report an 11-year-old girl with incidental bilateral accessory middle cerebral arteries, an extremely rare variation, which is the first case in the related literature demonstrated by cranial magnetic resonance imaging and magnetic resonance angiography.
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27
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Daghigi MH, Tubbs RS, Shoja MM, Shakeri AB, Pourisa M, Salter EG, Oakes WJ. Bilateral accessory middle cerebral arteries associated with an aneurysm of the anterior circulation. Folia Morphol (Warsz) 2006; 65:161-3. [PMID: 16773607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
An accessory middle cerebral artery is one variation of the intracranial vasculature that may be a source of misinterpretation by clinicians dealing with cerebrovascular diseases. We report a case of an elderly female found to have bilateral accessory middle cerebral arteries, who presented with the rupture of an aneurysm of the anterior part of the circle of Willis. Accessory middle cerebral arteries are rare anatomical findings and the bilateral occurrence is exceedingly rare. We believe this to be the first report of bilateral accessory middle cerebral arteries associated with an aneurysm of the anterior cerebral-anterior communicating arteries. The anatomical and clinical relevance of this variation is described.
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Affiliation(s)
- M H Daghigi
- Department of Radiology and Angiography, Tabriz University of Medical Sciences, Tabriz, Iran
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28
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Soncini E, Ronzoni E, Macovei D, Grignaffini A. Integrated monitoring of fetal growth restriction by computerized cardiotocography and Doppler flow velocimetry. Eur J Obstet Gynecol Reprod Biol 2006; 128:222-30. [PMID: 16431011 DOI: 10.1016/j.ejogrb.2006.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Revised: 12/16/2005] [Accepted: 01/01/2006] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the correlations between Doppler flow velocimetry and computerized cardiotocography (cCTG) in fetal growth restriction. STUDY DESIGN Fifty growth-restricted foetuses with abdominal circumference below the 10th percentile and no major abnormalities were studied. A total of 186 cCTG tracings (at least two per patient) analysed using the HP2CTG system were compared with the corresponding umbilical artery pulsatility index (PI), the PI ratio of umbilical artery to middle cerebral artery, and the ductus venosus systolic/atrial ratio. RESULTS Worsening in umbilical artery Doppler velocimetry parameters was associated with a significant reduction of short- and long-term variability indices and accelerations. When end-diastolic umbilical artery flow was preserved, a reversed ratio between umbilical artery and middle cerebral artery PIs was not correlated with a worsening of cCTG parameters; in the presence of umbilical artery absent or reversed flow, ductus venosus Doppler velocimetry abnormalities were correlated with a significant reduction of variability. When end-diastolic umbilical artery flow was preserved, there was a progressive increase in variability indices and accelerations with advancing gestational age. In the more compromised fetuses this "maturation" process of cCTG patterns was not found. CONCLUSION There is a strict correlation between Doppler velocimetry abnormalities and cCTG parameter deterioration, in particular between ductus venosus and variability.
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Affiliation(s)
- Emanuele Soncini
- Department of Gynaecology, Obstetrics and Neonatology, University of Parma, Parma, Italy.
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29
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Fernández-Bouzas A, Harmony T, Santiago-Rodríguez E, Ricardo-Garcell J, Fernández T, Avila-Acosta D. Schizencephaly with occlusion or absence of middle cerebral artery. Neuroradiology 2006; 48:171-5. [PMID: 16391916 DOI: 10.1007/s00234-005-0006-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Accepted: 07/30/2005] [Indexed: 10/25/2022]
Abstract
In a study of 160 infants with prenatal and/or perinatal risk factors for brain damage, we observed three cases of schizencephaly. All cases were unilateral, and the clefts had open lips. In two cases, magnetic resonance angiography showed occlusion or absence of the middle cerebral artery (MCA) on the affected side. Two of the patients, including one with absent flow in the MCA of the affected side, had ipsilateral cerebellar atrophy.
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Affiliation(s)
- A Fernández-Bouzas
- Instituto de Neurobiología de la Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Juriquilla, QRO, Mexico.
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30
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Affiliation(s)
- Gokmen Kahilogullari
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey.
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31
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Feng WF, Qi ST, Huang SP, Huang LJ. [Surgical treatment of anterior circulation aneurysm via pterion keyhole approach]. Di Yi Jun Yi Da Xue Xue Bao 2005; 25:1546-8, 1551. [PMID: 16361160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To investigate the feasibility of pterion keyhole approach with minimal invasion for treatment of the anterior circulation aneurysm. METHOD Aneurysm clipping through the pterion keyhole approach was performed in patients with anterior circulation aneurysms, including 9 with posterior communication artery aneurysms, 3 with middle cerebral artery aneurysms and 6 with anterior communication artery aneurysms, who were in stages I to III according to Hunt-Hess scale. RESULT All the aneurysms were clipped successfully. One patient with a left posterior communication artery aneurysm developed transient sensory aphasia and motor aphasia after surgery due to intraoperative aneurysm rupture. No facial paralysis occurred due to damage of the facial nerve. CONCLUSION The pterion keyhole approach is a very useful surgical approach for treatment of anterior circulation aneurysms on the basis of cautious determination of indications and careful operation planning.
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Affiliation(s)
- Wen-feng Feng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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32
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Briganti F, Tortora F, Elefante A, Volpe A, Maiuri F. Persistent carotid-vertebral anastomosis associated with contralateral accessory middle cerebral artery. Surg Radiol Anat 2005; 27:450-4. [PMID: 16261250 DOI: 10.1007/s00276-005-0002-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2004] [Accepted: 05/12/2005] [Indexed: 11/30/2022]
Abstract
An exceptional case is reported of a complex anomaly of the brain arteries including low left carotid bifurcation, persistent carotid-vertebral anastomosis on the left and accessory middle cerebral artery on the right; the whole posterior circulation was only filled through the anomalous anastomotic vessel which joined with the vertebral artery because of a contralateral hypoplasic vertebral artery and the absence of both posterior communicating arteries. This association has not been previously reported in the literature. The embryological processes leading to these arterial anomalies are discussed. Risks related to a severe carotid stenosis or occlusion and to surgical or endovascular procedures in patients harboring these arterial anomalies are emphasized.
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Abstract
BACKGROUND We report a vascular abnormality of the middle cerebral artery (MCA) that has not been described in the literature before. METHODS Two patients (1 male and 1 female; age 44 and 67 years, respectively) were found to have a vascular abnormality in which the main trunk of the MCA had a twig-like form. Both patients presented with intracranial hemorrhage. RESULTS In these 2 patients, the abnormality was seen before the genu of the MCA. They had an intracranial hemorrhage due to an associated aneurysm inside the twigs. The twig appeared to be a network between the bifurcation of internal carotid artery and insular segment of MCA, and it was different from the collateral circulation due to acquired occlusion or moyamoya disease. CONCLUSION This new type of vascular lesion of the MCA is not benign. It appears to be associated with the occurrence of an aneurysm, an important clinical aspect.
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Affiliation(s)
- Hon-Man Liu
- Department of Radiology, Division of Neurosurgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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34
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Parmar H, Sitoh YY, Hui F. Normal variants of the intracranial circulation demonstrated by MR angiography at 3T. Eur J Radiol 2005; 56:220-8. [PMID: 15950421 DOI: 10.1016/j.ejrad.2005.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Revised: 05/09/2005] [Accepted: 05/11/2005] [Indexed: 10/25/2022]
Abstract
Magnetic resonance angiography (MRA) at 3T offers increased signal to noise ratio with better background suppression, leading to exquisite depiction of the intracranial circulation. We present a pictorial review of the normal variations and anomalies of the intracranial circulation detected on MRA performed on a high field 3T clinical scanner using parallel imaging techniques. The salient imaging features of these anomalies and normal variations are discussed with relevance to clinical practice.
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Affiliation(s)
- H Parmar
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
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35
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Cekirge HS, Peynircioglu B, Saatci I. Endovascular treatment of an "anterior cerebral artery" aneurysm in a patient with "embryonic unfused middle cerebral artery" anomaly: a case report. Neuroradiology 2005; 47:690-4. [PMID: 15940529 DOI: 10.1007/s00234-005-1407-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Accepted: 03/25/2005] [Indexed: 10/25/2022]
Abstract
We report a unique case of an anterior cerebral artery aneurysm in a patient with embryonic unfused middle cerebral artery anomaly. The arterial twigs of the middle cerebral artery supply the entire middle cerebral artery territory including the lenticulostriate branches. There was a vessel incorporated into the aneurysm, which was referred to as an accessory middle cerebral artery and it gave rise to a lenticulostriate branch. The aneurysm was occluded with detachable coils using a remodeling technique. After successful occlusion of the aneurysm the so-called accessory middle cerebral artery including its lenticulostriate branch started to fill from the anomalous middle cerebral artery network and the patient did not experience any ischemic injury.
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Affiliation(s)
- H Saruhan Cekirge
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sihhiye, 06100 Ankara, Turkey
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36
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Uchino M, Kitajima S, Sakata Y, Honda M, Shibata I. Ruptured aneurysm at a duplicated middle cerebral artery with accessory middle cerebral artery. Acta Neurochir (Wien) 2004; 146:1373-4; discussion 1375. [PMID: 15340873 DOI: 10.1007/s00701-004-0353-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although many cerebral vascular anomalies are widely recognized, others are less well known or unclassified. Accessory middle cerebral artery (MCA) and duplicated MCA are among uncommon anomalies. We present a very rare case of subarachnoid haemorrhage due to rupture of a saccular aneurysm arising from a duplicated middle cerebral artery which was associated with an accessory middle cerebral artery.
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Affiliation(s)
- M Uchino
- Department of Neurosurgery, Toho University School of Medicine, Tokyo, Japan.
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37
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Naito K, Oya F, Takei YI, Yamamoto K, Ikeda SI. [Cervical myelopathy in a patient with congenital cervico-cerebral vascular malformation]. Rinsho Shinkeigaku 2004; 44:623-5. [PMID: 15515707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
We report a 50 year-old woman with cervical myelopathy. The patient, who had cutaneous angiomas in the right orbital area, became aware of left upper limb weakness when she woke up, followed by painful abnormal sensation in both axilla and arms. MRI revealed an intramedullar lesion mainly located in cervical cord at the level of C3-C4. Angiography showed that serpentine left vertebral artery entered the canalis vertebralis at C3 and fed the blood flow of bilateral middle cerebral arteries. In this case, the upper cervical spinal cord ischemia might be induced by hemodynamic insufficiency of the anterior spinal artery ascribed to congenital cervico-cerebral vascular malformation.
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Affiliation(s)
- Kosuke Naito
- Third Department of Medicine, Shinshu University School of Medicine
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38
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Karazincir S, Ada E, Sarsilmaz A, Sarilmaz A, Yalçin O, Vidinli B, Sahin E. [Frequency of vascular variations and anomalies accompanying intracranial aneurysms]. Tani Girisim Radyol 2004; 10:103-9. [PMID: 15236123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
PURPOSE Investigation of the sites of intracranial aneurysms and incidence of associated congenital variations or anomalies. MATERIALS AND METHODS One hundred and ninety cerebral angiography examinations that were positive for aneurysm were evaluated retrospectively. Fourteen cases with vasospasm were excluded and the remaining 176 patients were assessed for the location of the aneurysm and co-incidental vascular variations and/or anomalies. There were two observers in the study, one of whom was an experienced vascular radiologist. RESULTS The most frequent locations of aneurysms were the supraclinoid internal carotid artery (32%, n=74), anterior communicating artery (30%, n=68), and middle cerebral artery bifurcation (23%, n=52). Twenty-eight patients (17%) had multiple aneurysms. Ninety-one (52%) patients had a vascular anomaly or variation. Hypoplasia or agenesis of A1 segment of the anterior cerebral artery was found in 48 patients, an azygous anterior cerebral artery in 1, a frontoorbital artery in 1, a duplicated middle cerebral artery in 1, early bifurcation of the middle cerebral artery in 9, persistent fetal origin of the posterior cerebral artery in 26, fenestration of P1 segment of posterior cerebral artery in 1, agenesis of P1 segment of posterior cerebral artery in 1, fenestration of vertebral artery in 1, double trunk visualization of superior cerebellar artery in 2 patients. CONCLUSION Due to an increased hemodynamic stress, congenital anomalies of the intracranial arteries predispose to the formation of saccular aneurysms. Nomalies such as A1 hypoplasia or agenesis, azygous anterior cerebral artery, accessory middle cerebral artery and persistent trigeminal artery are detected more frequently in patients with cerebral aneurysms compared to the normal population. The location of aneurysms and the frequency of arterial variations and anomalies in this study correlated well with data found in previous studies.
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Affiliation(s)
- Sinem Karazincir
- Dokuz Eylül Universitesi Tip Fakültesi, Radyodiagnostik Anabilim Dali, Izmir, Turkey
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39
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Fujimoto M, Nakahara I, Tanaka M, Iwamuro Y, Watanabe Y, Harada K. [Multiple intracranial aneurysms and vascular abnormalities associated with neurofibromatosis type 1: a case report]. No Shinkei Geka 2004; 32:355-9. [PMID: 15227842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
We present an unusual case of multiple intracranial aneurysms, persistent primitive trigeminal artery (PPTA), and fenestration of the middle cerebral artery (MCA), associated with type 1 neurofibromatosis (NF 1). The patient was a 55-year-old woman in a state of semicoma. We observed widespread neurofibromas and café au lait spots on her trunk and limbs. Computed tomography (CT) scan revealed diffuse subarachnoid hemorrhage and right frontal intracerebral hemorrhage (WFNS grade IV, Fisher's classification group 4). Cerebral angiography showed two intracranial aneurysms at the anterior communicating artery, an aneurysm at the cavernous portion of the right carotid artery, a PPTA, and MCA fenestration. The patient remained in an apallic state, even after successful clipping of the anterior communicating artery aneurysms.
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40
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Hayashi T, Miyazaki H, Ichimura S, Ishiyama N. [A duplication of middle cerebral artery mimicking a cerebral aneurysm]. No To Shinkei 2004; 56:174-5. [PMID: 15098364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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41
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Hajro T, Ramić I, Alajbegović A. [Trombosis of the middle cerebral artery as the cause of cerebrovascular insult (CVI) and recognition of the etiologic factors for CVI]. Med Arh 2004; 58:239-40. [PMID: 15526594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In the paper is shown the case of the patient of the CVI life, age of 40 years. It was about the vascular lesion left of the temperoparienal MRA shew the amputation of amputation of the temporal branches art. cerebri medii from the left side. The patient 6 years before she suffered of CVI infract myocard after which she recovered well. After the performed neurologic and physiatric treatment it came to the strength of the rude motor strength with the normalization of the speech.
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Affiliation(s)
- Tarik Hajro
- Centar za pareaplegiju, Klinicki centar Univerziteta u Sarajevu
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42
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Affiliation(s)
- Takashi Tokunaga
- Department of Neurology, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kitaku, Osaka 530-0012, Japan.
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43
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Tanriover N, Kawashima M, Rhoton AL, Ulm AJ, Mericle RA. Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation. J Neurosurg 2003; 98:1277-90. [PMID: 12816276 DOI: 10.3171/jns.2003.98.6.1277] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The cortical arteries arising from the main trunk of the middle cerebral artery, proximal to its bifurcation or trifurcation, are called "early branches." The purpose of this study was to characterize these early branches. METHODS The early branches were characterized according to their sites and patterns of origin, diameters, and relative proximity to the internal carotid artery bifurcation, as well as the course and area of supply of their cortical branches based on an examination of 50 hemispheres. Special attention was directed to the perforating arteries that arose from the early branches and entered the anterior perforated substance. The anatomical findings were compared with data obtained from 109 angiograms. CONCLUSIONS Early branches directed to the temporal and frontal lobes were found in 90 and 32% of the hemispheres, respectively. The early branches that arose more proximally from the M1 segment were larger than those arising distally. Lenticulostriate arteries arose from 81% of the early frontal branches (EFBs) and from 48% of the early temporal branches (ETBs). An average of two cortical arteries arose from the EFBs and 1.3 from the ETBs, the most common of which supplied the temporopolar and orbitofrontal areas. Although the microsurgical anatomy of the early branches demonstrates abundant diversity, they can be classified into clearly defined patterns based on anatomical features. These patterns can prove helpful in evaluating angiographic data and in planning an operative procedure.
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Affiliation(s)
- Necmettin Tanriover
- Department of Neurological Surgery, University of Florida, Gainesville, Florida 32610-0265, USA
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44
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Abstract
PURPOSE To describe a patient with transient third nerve palsy as the possible presenting sign of intracranial arteriovenous malformation. METHOD Case report. RESULT A 24-year-old female presented to ophthalmic casualty with sudden onset binocular diplopia and was diagnosed to have right sided partial third nerve palsy. Within 30 hours the third nerve palsy had recovered completely. A MRI scan and subsequent carotid angiogram revealed a large, high flow, trans-cortical Spetzler-Martin grade 4 arteriovenous malformation. The feeder vessel of the AVM originated from the right middle cerebral artery. Superficial venous drainage was via the superficial middle cerebral vein to the right transverse sinus. The deep venous drainage was via thalamostriate veins into markedly dilated internal cerebral vein and vein of Galen (Great cerebral vein). Venous reflux was noted around the midbrain from the vein of Galen. CONCLUSIONS Transient third nerve palsy may rarely occur secondary to intracranial arteriovenous malformation. Ophthalmologists should consider neuroimaging in the investigations for transient cases of III nerve palsy in young patients.
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Affiliation(s)
- G Wu
- Department of Ophthalmology, Bradford Royal Infirmary, Bradford, UK
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45
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Li H, Wong KS, Kay R. Relationship between the Oxfordshire Community Stroke Project classification and vascular abnormalities in patients with predominantly intracranial atherosclerosis. J Neurol Sci 2003; 207:65-9. [PMID: 12614933 DOI: 10.1016/s0022-510x(02)00397-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Oxfordshire Community Stroke Project (OCSP) classification is a stroke classification based on clinical features collected at bedside. Previous studies reported good correlation between vascular abnormalities and OCSP mainly in populations not at risk of intracranial atherosclerosis. There have been limited data on the relationship between intracranial atherosclerosis and the OCSP classification. METHODS Consecutive Chinese patients admitted to a regional hospital with acute ischemic stroke were studied in Hong Kong. Stroke subtype was classified as total or partial anterior circulation infarct (TACI or PACI), posterior circulation infarct (POCI), or lacunar infarct (LACI), according to the OCSP method. Transcranial Doppler (TCD) was performed whenever possible to evaluate the intracranial arteries as well as the carotid arteries. National Institute of Health Stroke Scale (NIHSS) was used to assess the severity of stroke on admission. RESULTS Six hundred and ninety-nine consecutive patients were studied. On admission, 24 patients were classified as TACI (3.4%), 96 PACI (13.7%), 111 POCI (15.9%), and 468 LACI (67.0%). Of the 345 patients who had TCD evidence of intracranial or carotid artery abnormalities, 75% had intracranial involvement only, 5% extracranial involvement only and 20% had both intracranial and extracranial involvement. The frequencies of arterial abnormalities were found in 58% of TACIs, 48% of PACIs, 48% of POCIs and 50% of LACIs. There was no evidence that the frequencies of arterial abnormalities were different between the OCSP groups (P=0.8). Middle cerebral artery velocity was abnormal in 9 TACIs (38%), 32 PACIs (33%), 35 POCIs (32%) and 177 LACIs (38%) (P=0.6). Vertebrobasilar velocities were abnormal in 4 TACIs (17%), 20 PACIs (21%), 29 (26%) and 87 LACIs (19%) (P=0.3). The OCSP subtypes were associated with POCIs the severity of stroke. NIHSS score of > or =9 was found in 83% of TACIs, 18% of PACIs, 9% of POCIs, and 12% of LACIs (P<0.0001). CONCLUSIONS OCSP classification is not significantly related to the presence of vascular abnormalities among patients with predominantly intracranial atherosclerosis.
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Affiliation(s)
- Huan Li
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
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Moore C, Heck D, Beauchamp N, Gailloud P. Detection on CT angiography of an accessory middle cerebral artery simulating a fusiform aneurysm on MR angiography. AJR Am J Roentgenol 2003; 180:544-5. [PMID: 12540474 DOI: 10.2214/ajr.180.2.1800544a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ogungbo B. Size, course, distribution and anomalies of the middle cerebral artery in adult Nigerians. East Afr Med J 2003; 80:59. [PMID: 12755244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Idowu OE, Shokunbi MT, Malomo AO, Ogunbiyi JO. Size, course, distribution and anomalies of the middle cerebral artery in adult Nigerians. East Afr Med J 2002; 79:217-20. [PMID: 12625681 DOI: 10.4314/eamj.v79i4.8883] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the size, course, distribution and anomalies of the middle cerebral artery in adult Nigerians. DESIGN A retrospective study. SETTING Department of pathology, University College Hospital, Ibadan between April and September 1999. SUBJECTS One hundred middle cerebral arteries from patients' asymptomatic for central nervous system lesions, obtained at autopsy from fifty adult Nigerians were examined. RESULTS The MCA arose as the wider of the two terminal branches of the internal carotid artery (ICA). Its mean diameter was 3.49 mm (CI = 3.39-3.59 mm), while the mean pre-division length was 15.43 mm (CI = 14.59-16.27 mm). In 92% of specimens, the first branches were perforators. The early branches were destined solely to the temporal lobe pole in most hemispheres (85%). In most specimens, (81%) the main trunk bifurcated while in 13% it trifurcated. One accessory MCA, and the early branches were given off before the perforators in two middle cerebral arteries, making an incidence of anomalies of 3%. There was no aneurysm. CONCLUSION These results are similar to what has been described in the literature for Caucasians. It buttresses the assertion that anatomical anomalies of the MCA are rare. The rarity at autopsy of aneurysms of the MCA in asymptomatic Nigerian Africans is not explained by the gross morphology of this vessel.
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Affiliation(s)
- O E Idowu
- Department of Anatomy, University College Hospital, Ibadan, Nigeria
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Gailloud P, Albayram S, Fasel JHD, Beauchamp NJ, Murphy KJ. Angiographic and embryologic considerations in five cases of middle cerebral artery fenestration. AJNR Am J Neuroradiol 2002; 23:585-7. [PMID: 11950648 PMCID: PMC7975097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2000] [Accepted: 11/29/2001] [Indexed: 02/24/2023]
Abstract
Five cases of unilateral middle cerebral artery fenestration were observed during the prospective evaluation of 1466 consecutive cerebral angiograms (0.43% of 1170 patients) between January 1999 and July 2001. In each case, an early branching temporopolar artery was seen to arise from the inferior limb of the fenestrated segment. This finding suggests that early branching temporopolar arteries may participate in the formation of middle cerebral artery fenestration by interfering with the normal fetal development of the middle cerebral artery.
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Affiliation(s)
- Philippe Gailloud
- Interventional Neuroradiology, Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Abstract
Cerebral arteriovenous malformations (AVMs) are rarely associated with other vascular lesions. Our goal was to examine the incidence of the coexistence of cerebral AVMs and cerebral arterial fenestrations. During the past 18 years, 51 patients with a cerebral AVM were examined with selective cerebral angiography in our institution. We retrospectively reviewed these cerebral angiographies and noted associated cerebral arterial fenestrations. We found five fenestrations distributed among 3 patients. In each patient one fenestration was located in the vertebral artery (VA). In 1 patient there were additional basilar and left middle cerebral artery fenestrations. Vertebral artery angiography was performed in 43 of the 51 patients; thus, the frequency of coexistence of AVM and VA fenestration was 7% (3 of 43). Although the clinical significance may not be great, we found a noteworthy incidence of associated VA fenestrations in AVM cases.
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Affiliation(s)
- A Uchino
- Department of Radiology, Saga Medical School, Japan.
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