Severe left MCA syndrome with an occluded accessory MCA

Abstract

Co-author Major role in drafting and editing the case report. Senior resident during patient presentation.

Rare case of duplicated middle cerebral artery and acute ischaemic stroke managed successfully with mechanical thrombectomy

“…Missed vessels may be discovered only after thrombectomy 12. Intriguingly, a smaller stump may be confused with an aneurysm 13. Misdiagnosis can delay or stop patients from undergoing thrombectomy, one of the established treatments for stroke 14.…”

Vascular variants and the evaluation of patients with acute stroke

“…2 Two articles published in this issue of Neurology ® Clinical Practice demonstrate how knowledge on these anatomical variants can help guide therapeutic interventions in patients with acute stroke. 6,7 In the first case, Cooke et al describe a 37-year-old woman who had acute onset of a left MCA syndrome with aphasia and dense hemiplegia. The initial CT scan showed subtle early ischemic changes in the frontal lobe and a hyperdense MCA sign, and the perfusion study confirmed an area of penumbra involving the left MCA territory.…”

“…She underwent successful recanalization of the occluded accessory MCA with a stent retriever and had a good clinical outcome. 6 In the second case, Khrlobyan et al 7 describe a 91-year-old woman who also had acute onset of a severe left MCA syndrome. The baseline CT scan was normal, but CTA showed a patent but narrow left MCA and a small bulge at the origin of the ACA that the authors immediately identified as an occlusion at the origin of an accessory MCA.…”

“…The cases presented in this issue remind us of the importance of considering accessory and duplicated vessels. 6,7 As neurologists, we must always remember that although sophisticated imaging studies are available, our clinical evaluation and assessment should guide all our diagnostic and therapeutic decisions.…”