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LETTER TO EDITOR
Year : 2008  |  Volume : 56  |  Issue : 4  |  Page : 487-488

Infraoptic azygous anterior cerebral artery


1 Division of Interventional Neuroradiology, Max Institute of Neurosciences, Max Superspeciality Hospital, 1 Press Enclave Road, Saket, New Delhi-110 017, India
2 Division of Neurosurgery, Max Institute of Neurosciences, Max Superspeciality Hospital, 1 Press Enclave Road, Saket, New Delhi-110 017, India

Date of Acceptance13-Jul-2008

Correspondence Address:
Vipul Gupta
Division of Interventional Neuroradiology, Max Institute of Neurosciences, Max Superspeciality Hospital, 1 Press Enclave Road, Saket, New Delhi-110 017
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.44819

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How to cite this article:
Gupta V, Chugh M, Vaishya S. Infraoptic azygous anterior cerebral artery. Neurol India 2008;56:487-8

How to cite this URL:
Gupta V, Chugh M, Vaishya S. Infraoptic azygous anterior cerebral artery. Neurol India [serial online] 2008 [cited 2020 Sep 30];56:487-8. Available from: http://www.neurologyindia.com/text.asp?2008/56/4/487/44819


Sir,

A 22-year-old male presented with sudden headache and altered sensorium due to intracerebral hemorrhage [Figure 1A]. He had history of fever with elevated leukocyte counts. Echocardiogram showed valvular vegetations. DSA showed a mycotic aneurysm in the cortical branch of the right anterior cerebral artery (ACA). Infraoptic course of the azygous ACA was seen on the right side [Figure 1B] and [Figure 1C] with a hypoplastic left internal carotid artery (ICA) [Figure 1D],[Figure 1E] and [Figure 1F]. Surgical clipping of the aneurysm as well as evacuation of the hematoma was done. Patient consciousness improved after the surgery and he started following verbal commands. He had significant hemiparesis at the time of discharge and hasn't come back for follow-up.

An infraoptic course of the ACA is rare, with approximately 30 previously reported cases. [1],[2] Infraoptic ACA arises from the ICA at (or near) the origin of the ophthalmic artery instead of the usual site of origin at the ICA bifurcation. Angiography shows apparent low bifurcation of the ICA with the ACA arising near the ophthalmic artery which passes under the ipsilateral optic nerve before turning superiorly to join the normally positioned anterior communicating artery (AcomA). This anomaly may be detected on magnetic resonance (MR) angiography as a unusually low ICA bifurcation with the ACA ascending between the optic nerves. [3] It is most likely to be due to persistent in utero communication between the primitive dorsal and ventral ophthalmic arteries. [2] Another theory favors persistence and enlargement of prechiasmatic anastomosis between the prechiasmal branch of the ophthalmic artery and chiasmal branches of the ACA. [2] It can be associated with agenesis of the ICA, anomalous origin of the ipsilateral ophthalmic artery from the external circulation, fused pericallosal arteries, moyamoya disease, and symptoms related to the optic nerve or optic chiasma compression. [1] To the best of our knowledge ours is the first reported case of azygous ACA associated with infraoptic ACA. Additionally, our case had an unusual anomaly of hypoplastic contralateral ICA associated with dilated posterior communicating artery providing collateral flow to the ICA territory. The prevalence of cerebral aneurysms associated with an infraoptic course of the ACA is much higher and the most common site is at the ACA-AcomA complex. [4] Recognition of this anomaly is of considerable importance in planning surgery for ACA. [5] In our case the distal location of the aneurysm presence of infraoptic ACA didn't result in alteration of surgical planning. However, in the event of temporary clipping of ACA, awareness of the azygous variant could have been relevant.

 
  References Top

1.Given CA 2nd, Morris PP. Recognition and importance of an infraoptic anterior cerebral artery: Case report. AJNR Am J Neuroradiol 2002;23:452-4.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Spinnato S, Pasqualin A, Chioffi F, Da Pian R. Infraoptic course of the anterior cerebral artery associated with an anterior communicating artery aneurysm: Anatomic case report and embryological considerations. Neurosurgery1999;44:1315-9.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Given CA 2nd, Morris PP. Recognition and importance of an infraoptic anterior cerebral artery: case report. AJNR Am J Neuroradiol 2002;23:452-4.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Odake G. Carotid-anterior cerebral artery anastomosis with aneurysm: Case report and review of the literature. Neurosurgery 1988;23:654-8.  Back to cited text no. 4  [PUBMED]  
5.Senter HJ, Miller DJ. Interoptic course of the anterior cerebral artery associated with an anterior cerebral artery aneurysm: Case report. J Neurosurg 1982;56:302-4.  Back to cited text no. 5  [PUBMED]  


    Figures

  [Figure 1A], [Figure 1B], [Figure 1C], [Figure 1D], [Figure 1E], [Figure 1F]

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