Occlusion of the Anterior Cerebral Artery Mimicking a Cerebral Aneurysm: Clinical Presentation and Literature Review

2021 ◽  
Author(s):  
Yang Liu ◽  
Gaochao Guo ◽  
Zhu Lin ◽  
Liming Zhao ◽  
Juha Hernesniemi ◽  
...  
Keyword(s):  
Literature Review ◽  
Middle Cerebral Artery ◽  
Cerebral Aneurysm ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Clinical Presentation ◽  
Disease Patient ◽  
Extensive Literature ◽  
The Right

Abstract Background Intracranial aneurysms may be misdiagnosed with other vascular lesions such as vascular loops, infundibulum, or the stump of an occluded artery (very rare and reported compromising only the middle cerebral artery and the posterior circulation territory). Our aim was to describe a unique case of occlusion of an anterior cerebral artery mimicking a cerebral aneurysm in a probable moyamoya disease patient, and to highlight its clinical presentation, diagnosis, and management, and to perform an extensive literature review. Case A 67-year-old man suffering from recurrent dizziness for 3 months. Previous medical history was unremarkable. Brain magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) demonstrated occlusion of the right middle cerebral artery (MCA) associated with a “probable moyamoya disease” and an aneurysm-like shadow protruding lesion at the anterior communicating artery (AcomA). Perfusion images showed ischemia along the right temporo-occipital lobe. Due to MCA occlusion with perfusion deficits and unspecific symptoms, we offered a right side encephalo-duro-myo-synangiosis (EDMS) and clipping of the AcomA aneurysm in one session. Intraoperatively, there was no evidence of the AcomA aneurysm; instead, this finding corresponded to the stump of the occluded right anterior cerebral artery (A1 segment). This segment appeared to be of yellowish color due to atherosclerosis and lacked blood flow. The patient underwent as previously planned a right side EDMS and the perioperative course was uneventful without the presence of additional ischemic attacks. Conclusion Arterial branch occlusions can sometimes present atypical angiographic characteristics that can mimic a saccular intracranial aneurysm. It is relevant to consider this radiographic differential diagnosis, especially when aneurysm treatment is planned.

scholarly journals Ruptured Cerebral Aneurysm of Fenestrated A1 Segment of the Anterior Cerebral Artery: Case Report and Literature Review

2017 ◽  
Vol 11 (6) ◽  
pp. 309-314
Author(s):  
Junji Uno ◽  
Ryosuke Otsuji ◽  
Nice Ren ◽  
Shintaro Nagaoka ◽  
Katsuharu Kameda ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Cerebral Aneurysm ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery

A FORM OF DYSPLASIA OR A FORTUITOUS ASSOCIATION? A CEREBRAL ANEURYSM INSIDE AN ARACHNOID CYST

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. E654-E655 ◽  
Author(s):  
Marco A. Zanini ◽  
Antonio T. de Souza Faleiros ◽  
Gilberto Rondinelli ◽  
Roberto C. Gabarra ◽  
Luiz A. de Lima Resende
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Aneurysm ◽  
Temporal Bone ◽  
Arachnoid Cyst ◽  
Cerebral Artery ◽  
Clinical Presentation ◽  
Cranial Vault ◽  
Middle Fossa ◽  
Intracystic Hemorrhage

Abstract OBJECTIVE Although arachnoid cysts and intracranial aneurysms are very common lesions, their association in the same patient is rare. We present a case of a middle cerebral artery aneurysm ruptured into an arachnoid cyst. We found only six cases with intracystic hemorrhage reported in the literature. The presence of an arachnoid cyst can mislead clinical presentation. The patient presented a paradoxically small temporal fossa and thickening of the temporal and sphenoid bone. The authors suggest that this uncommon association (arachnoid cyst, atypical cranial vault, and “mirror-like” cerebral aneurysm) could represent a form of dysplasia. CLINICAL PRESENTATION A 46-year-old patient presented with a 3-week history of slight headaches, which had worsened in the last 3 days before presentation. Computed tomographic scans showed a cystic lesion located in the middle cranial fossa and sylvian fissure with suspected aneurysm dilation inside. Magnetic resonance imaging scans showed an intracystic hemorrhage but not subarachnoid hemorrhage. Paradoxically, changes in the cranial vault around the cyst were noted. Digital subtraction angiography showed bilateral “mirror” middle cerebral artery aneurysms. INTERVENTION A large right pterional craniotomy was performed with full microsurgical removal of the arachnoid cyst walls and aneurysm clipping. The aneurysm was in the medial wall of the arachnoid cyst with its dome inside the cyst. The contralateral aneurysm was clipped 2 weeks later. The follow-up period was uneventful, and the patient returned to normal life. CONCLUSION Rupture of a cerebral aneurysm into an arachnoid cyst is rare. Clinical presentation may be unusual because the cyst can prevent subarachnoid hemorrhage. A middle fossa cranial arachnoid cyst in the presence of temporal bone depression, small middle fossa, and thickness of squamous temporal bone and the lesser wing of sphenoid is rare and suggests that congenital factors may play an important role in their development. The exceptional association between “mirror” aneurysms and arachnoid cyst with bone changes suggests a possible congenital form of dysplasia.

The Accessory Middle Cerebral Artery: Anatomic Report

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS10-ONS14 ◽  
Author(s):  
Cassius V.C. Reis ◽  
Joseph M. Zabramski ◽  
Sam Safavi-Abbasi ◽  
Ricardo A. Hanel ◽  
Pushpa Deshmukh ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Inferior Frontal Gyrus ◽  
Cerebral Aneurysms ◽  
Optic Chiasm ◽  
Inferior Surface ◽  
Increased Risk ◽  
Accessory Middle Cerebral Artery

Abstract Objective: An accessory middle cerebral artery (MCA) usually originates between the A1 and proximal A2 segment of the anterior cerebral artery, reaches the sylvian fissure, and supplies the territory of the MCA. This anomaly has been associated with cerebral aneurysms and Moyamoya disease. We report an accessory MCA arising from the A2 segment. Methods: A cadaveric head, fixed in formalin solution and injected with red and blue silicone on its vascular tree to trace intracranial and extracranial vessels, was dissected. Results: An accessory MCA was found arising from the A2 segment of the anterior cerebral artery and feeding the basal and inferior surface of the inferior frontal gyrus. In our specimen, the vessel was associated with intracranial aneurysms at other locations. Conclusion: Although anomalies of the MCA are rare, neurosurgeons must be familiar with such anatomic variations. An accessory MCA can be associated with Moyamoya disease and aneurysms at its junction with the anterior cerebral artery. Patients with this anomaly may, therefore, have an increased risk for developing aneurysms and other neurovascular complications. By obstructing the surgical view, an accessory MCA may increase the difficulty of exposing lesions in the vicinity of the optic chiasm.

Abstract 1122‐000070: Multiple Watershed Strokes Following Catheter Ablation Procedure

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Denis Babici ◽  
Angel Bayas ◽  
Khalid Hanafy
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Carotid Arteries ◽  
Anterior Cerebral Artery ◽  
The United States ◽  
Ablation Procedure ◽  
The Right

Introduction : Cerebral watershed strokes involve the junction of two non‐anastomosing arterial systems, which are hemodynamic zones at risk. Strokes occur in 3% to 9% of patients after cardiac procedures. The mechanism underlying post‐cardiac surgery watershed stroke involves a combination of hypoperfusion and embolization, but the role of hypoperfusion has not been well elucidated. Watershed strokes in the general population are usually secondary to global hypoperfusion, such as during cardiac arrest, but may also be attributable to stenosis of the carotid artery or other major vessel, leading to local hypoperfusion. Atrial fibrillation confers a threefold to fivefold increase in the risk of stroke, causing 15–20% of all thromboembolic events in the United States. Catheter ablation of atrial fibrillation is the treatment of choice, and currently one of the most commonly performed electrophysiology procedures in the United States. Successful catheter ablation in patients with atrial fibrillation is associated with a decrease in systolic blood pressure. One study showed that in patients with hemodynamically significant stenosis, the average decrease in mean blood pressure during TIA attack was 26.4. mm Hg. In addition, carotid artery stenosis is frequently associated with stenosis of the vertebral arteries, carotid siphon, and cerebral arteries. In these patients, cerebral blood flow is directly dependent on perfusion pressure, due to the loss of normal autoregulatory capacity in the cerebral circulation. Methods : Single Case Study Results : 84‐year‐old male patient with a past medical history of hypertension, gastrointestinal hemorrhage, coronary artery disease status post coronary artery bypass graft, prostate cancer, and atrial flutter on Apixaban status post recent catheter ablation performed five days prior to presentation at the hospital. Patient presented to the emergency room with complaints of spotty vision. The remainder of the neurologic exam was unremarkable. Patient’s vision changes started after the cardiac ablation procedure and progressively worsened. At the time of assessment, NIH score was 1 due to left eye hemianopsia. CT scan of the head without contrast was done and was negative for hemorrhage. CTA of the neck showed 60% stenosis of the left carotid artery. MRI of the brain was done and showed infarct zones between the right anterior cerebral artery and right middle cerebral artery, the right middle cerebral artery and right posterior cerebral artery, the left anterior cerebral artery and left middle cerebral artery, and in the area supplied by the right posterior cerebral artery. Interestingly, based on the radiologic features, all of these strokes happened at approximately the same time. Conclusions : This case demonstrates that even in asymptomatic patients with hemodynamically insignificant carotid stenosis, hypotensive episodes can elicit hemodynamically significant changes that may result in ischemic stroke. Current guidelines don’t include radiologic assessment of the carotid arteries before catheter ablation procedure in patients with known atherosclerotic disease. Based on our findings, in patients with known atherosclerotic disease, we recommend radiologic assessment of the carotid arteries prior to catheter ablation. Patient who undergo catheter ablation usually have an echocardiogram done prior to the procedure.

Can Combined Bypass Surgery at Middle Cerebral Artery Territory Save Anterior Cerebral Artery Territory in Adult Moyamoya Disease?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 431-438 ◽  
Author(s):  
Won-Sang Cho ◽  
Jeong Eun Kim ◽  
Jin Chul Paeng ◽  
Minseok Suh ◽  
Yong-il Kim ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Anterior Cerebral Artery ◽  
Middle Cerebral Artery Territory ◽  
Reservoir Capacity ◽  
Hemodynamic Changes ◽  
Adult Moyamoya Disease

Abstract BACKGROUND: Patients with moyamoya disease are frequently encountered with improved symptoms related to anterior cerebral artery territory (ACAt) and middle cerebral artery territory (MCAt) after bypass surgery at MCAt. OBJECTIVE: To evaluate hemodynamic changes in MCAt and ACAt after bypass surgery in adult moyamoya disease. METHODS: Combined bypass surgery was performed on 140 hemispheres in 126 patients with MCAt symptoms. Among them, 87 hemispheres (62.1%) accompanied preoperative ACAt symptoms. Clinical, hemodynamic, and angiographic states were evaluated preoperatively and approximately 6 months after surgery. RESULTS: Preoperative symptoms resolved in 127 MCAt (90.7%) and 82 ACAt (94.3%). Hemodynamic analysis of total patients showed a significant improvement in MCAt basal perfusion and reservoir capacity (P < .001 and P = .002, respectively) and ACAt basal perfusion (P = .001). In a subgroup analysis, 82 hemispheres that completely recovered from preoperative ACAt symptoms showed a significant improvement in MCAt basal perfusion and reservoir capacity (P < .001 and P = .05, respectively) and ACAt basal perfusion (P = .04). Meanwhile, 53 hemispheres that had never experienced ACAt symptoms significantly improved MCAt basal perfusion and reservoir capacity (P < .001 and P = .05, respectively); however, no ACAt changes were observed. A qualitative angiographic analysis demonstrated a higher trend of leptomeningeal formation from MCAt to ACAt in the former subgroup (P = .05). During follow-up, no ACAt infarctions were observed. CONCLUSION: Combined bypass surgery at MCAt resulted in hemodynamic improvements in ACAt and MCAt, especially in patients with preoperative ACAt symptoms.

scholarly journals Moyamoya: An Uncommon Variant Of Stroke In Childrena

2018 ◽  
Vol 08 (03) ◽  
pp. 194-196
Author(s):  
Rida Zaheer ◽  
Ayesha Ahmed ◽  
Shazia Shakoor ◽  
Shakeel Ahmed
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Conservative Therapy ◽  
Unknown Etiology ◽  
Cerebrovascular Disorder ◽  
Ct Angiogram ◽  
History Of ◽  
The Right

Moyamoya is a rare cause of stroke in children. It is an infrequent cerebrovascular disorder of unknown etiology. We are reporting a case of a 7-year-old girl who presented with an acute history of left-sided weakness. On imaging she was diagnosed with Moyamoya disease. CT Angiogram revealed an occlusion of the right middle cerebral artery typical of Moyamoya disease. The child improved with conservative therapy.

scholarly journals 1679 An Unusual Case of Hypoplastic Internal Carotid Artery with Segmental Aplasia of The Anterior Cerebral Artery: A Case Report and Systematic Literature Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Whitley ◽  
P Skalicky ◽  
J Malik ◽  
F Charvat ◽  
V Benes ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Literature Review ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Unusual Case ◽  
Clinical Decision Making ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Ct Angiogram ◽  
The Right

Abstract Aim Hypoplasia of the internal carotid artery (ICA) is a rare morphological variant with potential implications in disease and clinical decision-making. We describe an unusual case of ICA hypoplasia in a 50-year-old female who presented with an acute episode of vertigo. CT angiogram showed an unusually short common carotid artery (CCA) on the right side, hypoplasia of the right ICA, and agenesis of the A1 segment of the right anterior cerebral artery (ACA). We provide a short review of the available literature. Method The literature review was performed according to PRISMA guidelines. Three databases (Pubmed, Web of Science, and Ovid) were searched using the terms “ICA” and “Hypoplasia”. Case reports published in English in the last 10 years were considered eligible for inclusion. Reports of acquired ICA hypoplasia or ICA agenesis were excluded. Results Our systematic literature search revealed that 19 cases of congenital ICA hypoplasia have been reported in the last 10 years. Of these, 14 were unilateral hypoplasia, including nine cases in which the anomaly was on the left, and five cases in which the anomaly was on the right. Two cases had additional aplasias; one with aplasia of the ACOM and another with aplasia of segment C6 of the ICA. Conclusions We conclude that ICA hypoplasia remains a rare anomaly, despite the increasing incidence due to the availability of imaging technology. Clinicians should be aware of these variations, as they are frequently associated with haemodynamic changes, aneurysms, and fenestrations. Such variations have important implications for planning angiographic and surgical approaches.

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