Twig-like Middle Cerebral Artery: a Seldom Vessel Anomaly of Important Relevance

Twig-like middle cerebral artery: Embryological persistence or secondary consequences?

“…Shin et al subsequently reported four cases in 2014. 5 Common angiographical features of these cases are as follows; 1) a steno-occlusive lesion at the unilateral MCA, 4,5,10,11 except for one bilateral case, 12 2) plexiform arterial network replacing the proximal MCA trunk, 3) LSAs arising from the plexiform arterial network, 4) normal cortical branches beyond the affected MCA trunk with anterograde flow, and 5) compromised blood flow to the distal MCA with compensatory leptomeningeal collaterals from anterior and posterior cerebral arteries. 9 Almost half of the cases presented with intracranial hemorrhage, and few cases were found incidentally.…”

Aplastic or Twig-Like Middle Cerebral Artery Presenting with Intracerebral Hemorrhage During Pregnancy: Report of Two Cases

“…There have been only a few reports describing Ap/T-MCA with their clinical features and pathogenesis being not well known. Some authors have called this entity “unfused MCA,” “aplastic MCA,” “twig-like MCA,” “unfused/twig-like MCA,” and “Ap/T-MCA.”1, 3, 4, 5, 6, 7, 8, 9, 10, 11 The term of this entity in this report was unified as “Ap/T-MCA.”…”

“…Although there have been no distinct diagnostic criteria, according to the previous reports, angiographic features of Ap/T-MCA are as follow:1, 3, 4, 5, 6, 7, 8, 9, 10, 11 1) mixed patterns of plexiform arterial network and a steno-occlusive lesion exist on the unilateral MCA; 2) the LSAs arise from the plexiform arterial network instead of a normal MCA; 3) cortical branches of the MCA beyond the plexiform arterial network maintain a normal vessel caliber with anterograde flow; and 4) transdural collaterals were not found. A leptomeningeal collateral from either the anterior cerebral artery or posterior cerebral artery is observed in some cases 3 .…”

“…The diagnosis of the Ap/T-MCA based on CTA and MRA is difficult, and misdiagnosis as unilateral moyamoya disease (MMD), atherosclerotic steno-occlusive disease, or arteriovenous malformation occurs 3, 9, 10. Cerebral angiography is the gold standard for diagnosis of the Ap/T-MCA 3 .…”

“…There are several MCA anomalies:1, 2 accessory MCA, duplicated MCA, fenestrated MCA, and aplastic or twig-like MCA (Ap/T-MCA). In an Ap/T-MCA, the MCA trunk has either a stenosis or occlusion accompanied by collateral plexiform networks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11. Although there have been only a few reports describing Ap/T-MCA with the clinical features and pathogenesis being not well defined, an Ap/T-MCA can cause both ischemic and hemorrhagic strokes and frequently harbors aneurysms 3 …”