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|Year : 2017 | Volume
| Issue : 5 | Page : 1198-1200
Incidental finding of an accessory middle cerebral artery in a patient with multiple aneurysms
Manish Garg, Shaam Bodeliwala, Vikas Kumar, Anita Jagetia
Department of Neurosurgery, GB Pant Institute of Postgraduate Medical Education and Research and Maulana Azad Medical College, New Delhi, India
|Date of Web Publication||6-Sep-2017|
Department of Neurosurgery, GB Pant Institute of Postgraduate Medical Education and Research and Maulana Azad Medical College, New Delhi - 110 002
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Garg M, Bodeliwala S, Kumar V, Jagetia A. Incidental finding of an accessory middle cerebral artery in a patient with multiple aneurysms. Neurol India 2017;65:1198-200
|How to cite this URL:|
Garg M, Bodeliwala S, Kumar V, Jagetia A. Incidental finding of an accessory middle cerebral artery in a patient with multiple aneurysms. Neurol India [serial online] 2017 [cited 2019 Aug 21];65:1198-200. Available from: http://www.neurologyindia.com/text.asp?2017/65/5/1198/214044
Anomalies of the middle cerebral artery (MCA) are infrequently recognized and reported, as their incidence is as low as 0.3–4%. We are reporting a case of an accessory MCA in a patient having multiple aneurysms, as seen on the computed tomography angiography (CTA) of the brain. A 38-year old male patient presented with subarachnoid hemorrhage in the right Sylvian fissure, suprasellar cistern, and prepontine cistern with bilateral intraventricular hemorrhage. The CTA showed two well-defined outpouchings: one of them measured 4 × 4 mm, arising from the right internal carotid artery (ICA) bifurcation, with a neck of 1.7 mm; and, the other measured 3 × 3 mm and was located at the origin of the anterior communicating artery (AComA). An accessory MCA was visible on the left side, which arose from the left A2 segment and was running parallel to the left MCA in the Sylvian fissure [Figure 1], [Figure 2], [Figure 3].,,,,,
|Figure 1: CT angiography of the brain showed the left accessory middle cerebral artery (white arrow) and right ICA aneurysm (black arrow)|
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|Table 1: Review of literature showing accessory MCA associated with an aneurysm|
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Anomalies of the MCA are uncommon. Among them, duplication and early bifurcation are more common than the presence of an accessory MCA. The embryological significance of the MCA irregularities are not completely described. Whether they are the result of early alterations in the blood flow dynamics, or they represent a persistent fetal vascular supply, has not been unequivocally determined. Yamamoto et al., suggested that the accessory MCA is a residual congenital artery and that the duplicated MCA represents an early ICA bifurcation. Twenty-two cases of an accessory MCA associated with the AComA complex aneurysms have been reported. Altered hemodynamics may play a role in the development of an aneurysm because filling of the accessory MCA from the left A2 leads to a high flow system within the AComA, which may result in the development of an aneurysm. Our case was unique because the patient had two aneurysms (one present on the right ICA and the other on the AComA) associated with an accessory MCA.
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[Figure 1], [Figure 2], [Figure 3]