Twig-like middle cerebral artery: Embryological persistence or secondary consequences?

Ota, Takahiro; Komiyama, Masaki

doi:10.1177/15910199211024077

Cited by 19 publications

(24 citation statements)

References 15 publications

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“…The middle cerebral artery is formed by the fusion of reticulated vascular networks in utero [ 3 ]. It has been reported that this disease is caused by unknown factors hindering fusion in the M1 region and that a small network of vessels remains only in the horizontal region [ 3 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

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A case of cerebral infarction due to aplastic or twig-like middle cerebral artery after lung cancer surgery

Hato

Yamaguchi

Sugiyama

et al. 2022

Journal of Surgical Case Reports

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Aplastic/twig-like middle cerebral artery is a rare vascular abnormality. We report a case of postoperative cerebral infarction caused by this disease. The patient is a male in his 40s. A 9-cm tumour was revealed to have invaded the superior vena cava from his right lung. He underwent right upper and middle bilobectomy. Due to the vascular invasion, the intraoperative bleeding exceeded 2 litres. Mechanical ventilation was required for postoperative pneumonia. After extubation, he was unable to write and was found to have cerebral infiltration in the left middle cerebral artery region. The cause of the cerebral infarction was investigated, but no thrombus in the left atrium or arteriosclerosis was found. No atrial fibrillation was observed during or after the surgery. Magnetic resonance angiography of the brain revealed an aplastic/twig-like middle cerebral artery.

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Section: Discussionmentioning

confidence: 99%

“…The diagnosis of Ap/twig-like MCA is based on angiographic imaging. Differentiation from moyamoya disease is particularly important for the diagnosis [ 3 , 6 , 8 ]. Unlike moyamoya disease, Ap/twig-like MCA is unilateral [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

A case of cerebral infarction due to aplastic or twig-like middle cerebral artery after lung cancer surgery

Hato

Yamaguchi

Sugiyama

et al. 2022

Journal of Surgical Case Reports

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“…To date, common angiographical features of Ap/T-MCA are described as follows: 1) a steno-occlusive lesion can be seen on the unilateral MCA, 2) plexiform arterial network exists instead of the main MCA trunk, 3) perforators arise from the plexiform arterial network, and 4) cortical branches beyond the occluded MCA trunk have an anterograde flow with a normal configuration. [10][11][12] It is considered that MCA hypoplasia occurs because of the twig-like network remnants that exist at the time of MCA development. Reported characteristics of an Ap/T-MCA are stenosis or occlusive lesions confined to the unilateral M1.…”

Section: Discussionmentioning

confidence: 99%

“…It is difficult to differentiate the two diseases; however, the following characteristics should be helpful: Ap/T-MCA is further characterized by normal vasculature beyond M2 and in other arteries, no collateral blood flow from the ECA, and no progression of the lesion. [10][11][12] Ap/T-MCA is a very rare condition, accounting for 0.11-1.17% of serial cerebral angiography cases, and is associated with bleeding events in more than half of these cases, with aneurysms often occurring in abnormal vessels. [6][7][8]13,14 The present case had the angiographical features of an Ap/T-MCA.…”

Section: Discussionmentioning

confidence: 99%

“…11 Embryologically, the ICA and MCA should form first, otherwise the affected cerebral hemisphere will not develop normally. 11 In fact, deformed and discoloured M1 trunks have been observed in intraoperative findings, 8 and similar to the present case, a cord-like M1 trunk has been identified on MRI in a previous report. 14 This suggests that the changes are not completely aplastic in the foetal period, but secondary to stenosis and occlusion of the proximal MCA.…”

Section: Discussionmentioning

confidence: 99%

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Aplastic or twig-like middle cerebral artery and cardiogenic cerebral embolism mimicking moyamoya disease with RNF213 polymorphism: A case report

et al. 2021

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Progressive stenosis and occlusion of the bilateral internal carotid artery terminals and circle of Willis are typical features of Moyamoya disease. However, aplastic or twig-like middle cerebral artery (Ap/T-MCA)—wherein the unilateral main trunk of the middle cerebral artery (MCA) is not depicted, and a plexiform arterial network is formed—is similar to the findings of Moyamoya disease. Here, we describe a 78-year-old man who presented with mild right paralysis and aphasia. Magnetic resonance angiography (MRA) at admission did not show the bilateral MCAs. The findings were similar to those of Moyamoya disease, and his symptoms worsened after hospitalization. Endovascular treatment was performed, and the left MCA was completely recanalized. Later, paroxysmal atrial fibrillation was detected, and we finally determined that left MCA occlusion had occurred due to embolism. The right MCA was completely occluded at its origin, indicating an Ap/T-MCA. Embolic occlusion of the unilateral MCA and contralateral Ap/T-MCA made this case resemble Moyamoya disease in the acute stage. Even when chronic occlusion is suspected on MRA in acute cerebral infarction, endovascular treatment should be considered. Additionally, a heterotypic R4810K polymorphism was later found in the RNF213 gene. To our knowledge, this is the second report of Ap/T-MCA with the RNF213 gene polymorphism; however, their association remains unclear and requires further analyses.

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Triplicated middle cerebral arteries (duplicated and ipsilateral accessory) associated with triplicated anterior cerebral arteries (accessory) diagnosed by magnetic resonance angiography

Uchino,

Tokushige

2024

Surg Radiol Anat

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To describe a case of duplicated middle cerebral artery (MCA) combined with ipsilateral accessory MCA, forming a triplicated MCA, associated with the accessory anterior cerebral artery (ACA), forming a triplicated A2 segment of the ACA detected incidentally on magnetic resonance (MR) angiography. MethodsA 70-year-old woman with internal carotid artery (ICA) stenosis at the origin, which was detected by ultrasound, underwent cranial MR imaging and MR angiography of the intracranial region for an evaluation of brain and cerebral arterial lesions. The MR machine was a 3-Tesla scanner. MR angiography was performed using a standard 3-dimensional time-of-ight technique. ResultsMultiple ischemic white matter lesions are observed. No signi cant stenotic lesions were observed in intracranial arteries. The right duplicated MCA, main MCA, and right accessory MCA arose from the A2 segment of the right ACA. Thus, the right MCA was triplicated. There was also an accessory ACA forming a triplicated ACA at its A2 segment. These ndings were clearly identi ed on partial volume-rendering (VR) images. ConclusionWe herein report a case of triplicated MCA associated with triplicated ACA. MCA variations are relatively rare, and this is the third case of triplicated MCA reported in relevant English-language literature. To identify multiple cerebral arterial variations, creating partial VR images using MR angiographic source images is useful.

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Twig-like middle cerebral artery: Embryological persistence or secondary consequences?

Cited by 19 publications

References 15 publications

A case of cerebral infarction due to aplastic or twig-like middle cerebral artery after lung cancer surgery

A case of cerebral infarction due to aplastic or twig-like middle cerebral artery after lung cancer surgery

Aplastic or twig-like middle cerebral artery and cardiogenic cerebral embolism mimicking moyamoya disease with RNF213 polymorphism: A case report

Triplicated middle cerebral arteries (duplicated and ipsilateral accessory) associated with triplicated anterior cerebral arteries (accessory) diagnosed by magnetic resonance angiography

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