Abstract
The stump of an occluded middle cerebral artery (MCA) is a rare but important aneurysm mimic. A 57-year-old male was admitted due to recurrent onset of transient ischemic attack. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) showed a total obstruction in the right MCA with moyamoya phenomenon at distal trunks and a protruding lesion in the left MCA bifurcation. The patient was diagnosed with left MCA bifurcation aneurysm. Intraoperatively, the lesion was found to be an occluded right MCA stump. Encephalomyoarteriosynangiosis was performed, and the patient remained symptom-free at the 6-month follow-up. The possibility of a vascular stump should be considered when an aneurismal lesion is present at the MCA bifurcation with moyamoya phenomenon at distal trunks.
Highlights
CASE REPORTIntracranial vascular lesions, such as a vascular loop, infundibulum, and stump of an occluded vessel, are sometimes misdiagnosed as aneurysms during imaging examinations.[1]
The patient was diagnosed with left middle cerebral artery (MCA) bifurcation aneurysm on the basis of the Computed tomography angiography (CTA) findings
Digital subtraction angiography (DSA) was performed and showed occlusion of the right MCA and saccular out-pouching of the left MCA bifurcation
Summary
Intracranial vascular lesions, such as a vascular loop, infundibulum, and stump of an occluded vessel, are sometimes misdiagnosed as aneurysms during imaging examinations.[1]. A CT angiography (CTA) was performed and showed total occlusion at the proximal segment of the right MCA. A protruding lesion of 2.1 mm × 3.8 mm was seen in the left MCA bifurcation with distal moyamoya phenomenon (Fig.1B). The patient was diagnosed with left MCA bifurcation aneurysm on the basis of the CTA findings. Digital subtraction angiography (DSA) was performed and showed occlusion of the right MCA and saccular out-pouching of the left MCA bifurcation. A moyamoya lesion was noticed at the distal segments beyond the site of occlusion (Fig.1C). The patient was diagnosed with MCA bifurcation aneurysm and transient ischemic attack. The lesion was found to be an occluded right MCA stump (Fig.1D). The patient did not suffer from transient ischemic attack or seizures for six months after surgery
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