Abstract
Background:Ischemic stroke associated with an anomaly of the middle cerebral artery (MCA) is a rare occurrence. The diagnosis is very difficult when there are steno-occlusive lesions associated with an accessory middle cerebral artery (AMCA).Case Description:A 77-year-old female with hypertension and hyperlipidemia experienced repeated transient ischemic attacks (TIAs) of motor aphasia and dysarthria. Although angiography showed only left intracranial occlusion, the fusion images of three-dimensional digital subtraction angiography (3-D DSA) showed complex steno-occlusive lesions and an AMCA related with the TIA. The cerebral blood flow (CBF) to the left frontal lobe was supplied by the AMCA, via the anterior communicating artery from the right internal carotid artery. The left temporal and parietal lobes were supplied by the stenotic MCA, via the left posterior communicating artery from the left posterior cerebral artery. Single-photon emission computed tomography showed a marked decrease in CBF to both the left frontal and temporal lobes. A left superficial temporal artery (STA)-to-left MCA double anastomosis was performed, in which each branch of the STA supplied branches of the AMCA and MCA.Conclusion:This is the first reported case of ischemic stroke in a patient with an AMCA. The exact diagnosis could be made only by using fusion images of 3-D DSA, which were useful for understanding the complicated CBF pattern and for the choice of recipient artery in bypass surgery.
Highlights
Ischemic stroke associated with an anomaly of the middle cerebral artery (MCA) is a rare occurrence
There are numerous reports of accessory middle cerebral artery (AMCA) that focus on the association of the AMCA with cerebral aneurysm, but only a few cases have involved an ischemic event.[2,5,9,16,19]
This report describes the first case of surgical intervention for transient ischemic attack (TIA) due to a hemodynamic mechanism associated with an AMCA
Summary
Ischemic stroke associated with an anomaly of the middle cerebral artery (MCA) is a rare occurrence. The diagnosis is very difficult when there are steno‐occlusive lesions associated with an accessory middle cerebral artery (AMCA). Angiography showed only left intracranial occlusion, the fusion images of three‐dimensional digital subtraction angiography (3‐D DSA) showed complex steno‐occlusive lesions and an AMCA related with the TIA. The cerebral blood flow (CBF) to the left frontal lobe was supplied by the AMCA, via the anterior communicating artery from the right internal carotid artery. The left temporal and parietal lobes were supplied by the stenotic MCA, via the left posterior communicating artery from the left posterior cerebral artery. Single‐photon emission computed tomography showed a marked decrease in CBF to both the left frontal and temporal lobes. A left superficial temporal artery (STA)‐to‐left MCA double anastomosis was performed, in which each branch of the STA supplied branches of the AMCA and MCA
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have