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NEUROIMAGES
Year : 2017  |  Volume : 65  |  Issue : 5  |  Page : 1198-1200

Incidental finding of an accessory middle cerebral artery in a patient with multiple aneurysms


Department of Neurosurgery, GB Pant Institute of Postgraduate Medical Education and Research and Maulana Azad Medical College, New Delhi, India

Date of Web Publication6-Sep-2017

Correspondence Address:
Manish Garg
Department of Neurosurgery, GB Pant Institute of Postgraduate Medical Education and Research and Maulana Azad Medical College, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/neuroindia.NI_280_17

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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 Dec 12];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%.[1] 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].[4],[5],[6],[7],[8],[9]
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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Figure 2: Left accessory MCA (white arrow)

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Figure 3: AcomA aneurysm (black arrow) and accessory MCA (white 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.,[2] 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.[3] 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.[3] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jain K. Some observations on the anatomy of the middle cerebral artery. Can J Surg 1964;7:134-9.  Back to cited text no. 1
    
2.
Yamamoto H, Marubayashi T, Soejima T, Matsuoka S, Matsukado Y, Ushio Y. Accessory middle cerebral artery and duplication of middle cerebral artery: Terminology, incidence, vascular etiology, and developmental significance. Neurol Med Chir 1992;32:262-7.  Back to cited text no. 2
    
3.
Nakamura T, Houkin K, Saitoh H, Abe H. Aneurysm of the anterior communicating artery associated with accessory middle cerebral artery—Case report. Neurol Med Chir 1997;37:747-51.  Back to cited text no. 3
    
4.
Stabler J. Two cases of accessory middle cerebral artery, including one with an aneurysm at its origin. Br J Radiol 1970;43:314-8.  Back to cited text no. 4
[PUBMED]    
5.
Miyazaki S, Ito K, Ishii S. Aneurysm at the origin of the accessory middle cerebral artery. Surg Neurol 1984;22:292-4.  Back to cited text no. 5
[PUBMED]    
6.
Yamamoto H, Marubayashi T, Soejima T, Masuoka S, Matsukado Y, Ushio Y. Accessory middle cerebral artery and duplication of middle cerebral artery. Neurol Med Chir 1992;32:262-7.  Back to cited text no. 6
    
7.
Nakamura T, Houkin K, Saitoh H, Abe H. Aneurysm of the anterior communicating artery associated with accessory middle cerebral artery – Case report. Neurol Med Chir 1997;37:747-51.  Back to cited text no. 7
    
8.
Uchino M, Kitajima S, Sakata Y, Honda M, Shibata I. Ruptured aneurysm at a duplicated middle cerebral artery with accessory middle cerebral artery. Acta Neurochir 2004;146:1373-5.  Back to cited text no. 8
[PUBMED]    
9.
Lee IH, Jeon P, Kim KH, Byun HS, Kim HJ, Kim ST, Kim JS. Endovascular treatment of a ruptured accessory middle cerebral artery aneurysm. J Clin Neurosci 2010;17:383-4.  Back to cited text no. 9
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
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