Occlusion of the Middle Cerebral Artery Branch Mimicking Aneurysm

Abstract

A 26-year-old man was admitted to our department due to intermittent left hemiparesis for 3 months. Magnetic resonance image showed subacute infarction in the right precentral gyrus. Digital subtraction angiography and magnetic resonance angiography revealed an aneurysmal protrusion at the right middle cerebral artery (MCA) bifurcation. It was difficult to differentiate the aneurysm from the occlusion of the middle trunk of the MCA trifurcation. Brain single photon emission computerized tomography showed a decrease in perfusion in the right posterior frontal lobe without vascular reserve. Therefore, we planned a superficial temporal artery-MCA anastomosis with an exploration of the right MCA bifurcation. Intraoperatively, the aneurysmal opacification on preoperative angiography proved to be the proximal stump of the occluded middle trunk of the MCA trifurcation. An aneurysmal protrusion at the MCA bifurcation does not always indicate an aneurysm. In diagnosing protruding vascular lesions at the MCA bifurcation, the possibility of a vascular stump should be considered according to their angioanatomical appearance and the history of the patient.

Occluded middle cerebral artery vascular stump mimicking aneurysm: Case report and review of literature

“…In the case of a vascular stump, previous studies have suggested that clipping should not be performed. 1 , 4 In our case, the distal location of the moyamoya phenomenon relative to the occlusion site indicated compensation of the collaterals. However, the patient had symptoms of transient ischemia, which suggested that the compensation was inadequate to maintain sufficient blood flow.…”

“…Several cases of MCA vascular stump have been reported. 1 , 4 , 7 Previous studies have suggested that the MCA M2 segment may split into 2 or 3 main trunks. 8 In the case of a trifurcation, the stump of an occluded M2 segment may be easily recognized as an aneurysm located at the MCA bifurcation on the basis of the imaging findings.…”

“…Previous reports have found that most vascular stumps mimicking aneurysms are observed in the posterior circulation. 1 - 4 Here, we report a unique case of an occluded middle cerebral artery (MCA) stump mimicking an MCA bifurcation aneurysm.…”

Subarachnoid hemorrhage due to middle cerebral artery dissection mimicking aneurysm - Case report

“…Hemorrhage from a dissecting aneurysm may be unrecognized or misdiagnosed as an unexplained SAH because of the difficulty in angiographic diagnosis [7 , 9] . The proximal part of the occluded MCA segment can mimic a saccular aneurysm, and it influences treatment modalities [9 , 11] .…”

“…Two authors showed that the proximal stump of the occluded MCA dissection could mimic a saccular aneurysm [9 , 11] . The shape of the proximal stump mimicking a saccular aneurysm was conical [9 , 11] . Khattar et al.…”