“…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 …”