Background. The anterior communicating artery (ACoA) complex consists of the ACoA, the pre-and post-communicating segments of the anterior cerebral artery, and the recurrent artery of Heubner. It is the most common site for anatomical variations in the circle of Willis. Such variations can mimic intracranial aneurysms. Case description. A 30-year-old female presented with recurrent episodes of extreme headache and bilateral tinnitus. A brain computed tomography (CT) scan showed no significant lesions, while her CT-angiography (CTA) showed an enlarged vascular lesion at the ACoA, raising the suspicion for an ACoA aneurysm. A repeated CTA revealed a rare anatomical variation with a pattern of cross dominance in the ACoA complex; the left A1 and right A2 were dominant-enlarged, resulting in an enlargement of the ACoA. The presence of an ACoA aneurysm was hence excluded and the patient was managed conservatively. At 6-month follow-up, CTA showed no new findings.  Conclusion. ACoA enlargement can result from unequal hemodynamics around the ACoA complex, which may be mistaken for an aneurysm. A thorough study of the imaging data is of pivotal importance and may change the management strategy.

Background: The right-sided aortic arch (RAA) is an uncommon anatomical anomaly found in <0.1% of the adult population. In this article, we report a case of RAA anomaly with an aberrant left subclavian artery (ALSA) and Kommerell’s diverticulum associated with aneurysmal dilation of the ascending aorta, left carotid artery (CCA) stenosis, and pancake kidney presented with a transient ischemic attack (TIA). To the best of our knowledge, this is the first case in the literature that discusses such associations, especially in a symptomatic patient with neurological rather than tracheaesophageal symptoms and in the absence of the steal phenomenon. Case Description: A 52-year-old male, with a history of recurrent multiple TIAs, presented immediately after the onset of blurred vision and left-sided weakness. The initial diagnostic cerebral angiogram revealed a left CCA stenosis of <30%, with normal posterior circulation vasculature. The diagnosis of RAA was made with computed tomography angiography (CTA) of the thoracic and abdominal aorta, which revealed Type 2 RAA, with ALSA, which had a bullous dilatation at its origin that suggests Kommerell’s diverticulum. Another two findings on CTA were a persistent left-sided superior vena cava that ended in the coronary sinus and a single pelvic fused renal mass (Pancake kidney). Conclusion: We presented an extremely rare case of RAA with ALSA associated with a group of extra rare anomalies. Understanding the anatomical variants of RAA and its characteristics is critical to improving the management and follow-up of patients with such anomalies.

Background: Intracranial dolichoectasia (IADE) is a rare vascular disease characterized by distension, elongation and tortuosity of an artery. IADE rarely involves pediatric aged groups. It is either asymptomatic or manifests as ischemic or hemorrhagic attacks. Case description: A healthy, 30-year-old, female teacher presented with recurrent attacks of bi-frontal headaches associated with dizziness and dropping attacks of two-week duration. She was referred by her general physician to our institution of Neurosurgery Teaching Hospital in Baghdad, Iraq with a suspicion of medial temporal lesion on a cranial computed tomography (CT) scan. Magnetic resonance imaging study excluded the diagnosis suggesting a dolichoectatic middle cerebral artery that was confirmed by CT-angiography. Conclusion: Dolichoectasia of the middle cerebral artery is a rare and benign lesion. However, it can masquerade as cerebral cavernous malformation or intracranial arterial aneurysm. Thus, careful radiological evaluation with the suggested diagnostic criteria are of paramount importance to prevent its misdiagnosis.