We report a case of a 24-week-old fetus with cerebral anomalies suggestive of lobar holoprosencephaly including an unusual course of the anterior cerebral artery on Doppler examination. This abnormal trajectory of the anterior cerebral artery in holoprosencephalic brains has been described by pathologists, neurosurgeons and radiologists but our case indicates that this finding may be a useful adjunct to confirm such a difficult diagnosis prenatally.

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Background The prenatal diagnosis of alobar and semi lobar holoprosencephaly is accesible in routine ultrasound. In contrast the diagnosis of lobar holoprosencephaly is still difficult. Prenataly differential diagnosis of lobar holoprosencephaly with septal defects is important for counseling. Case report We describe the shape and trajectory by color Doppler of the anterior cerebral artery in a case of lobar holoprosencephaly. Results The anterior cerebral artery runs under the frontal bones and is a key to the diagnosis of fusion of the two frontal gyri. This has already been described on angiography in children with holoprosencephaly Conclusion This aspect in color Doppler of the anterior cerebral artery is particularly useful in the difficult diagnosis of lobar holoprosencephaly

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