Fenestration of the Middle Cerebral Artery associated with Cerebral Infarction

Abstract

Two cases of angiographically demonstrated fenestration of the middle cerebral artery associated with cerebral infarction are presented. The clinical significance of the coexistence of the fenestration and infarction in the territory of the lenticulostriate artery originating from the fenestration is discussed. Case 1. A 69-year-old male with a history of arterial fibrillation was suddenly seized with left hemiparesis. Right carotid angiography demonstrated a fenestration of the middle cerebral artery from which the lateral lenticulostriate artery originated. Follow-up computerized tomography (CT) scan showed an infarction in the right putaminal area. Case 2. A 75-year-old male was admitted after an attack of right hemiparesis and motor aphasia. Left carotid angiography showed a fenestration of the left middle cerebral artery from which the intermediate lenticulostriate artery was branching. The wall of the cervical-internal carotid artery was irregular. Follow-up CT scan showed an infarction in the left internal capsule. From these cases, it is suggested that fenestration of the sphenoidal portion of the middle cerebral artery may play a role in producing an infarct in the region of the basal ganglia, probably due to hemodynamic changes caused by the anatomical abnormality.