Rapid Evaluation of Collateral Development by Axial Time-Sequential CT Angiogram Covering Only 4-cm Width With A Focus On The Middle Cerebral Artery To Identify Candidates Of Thrombectomy

Background: Aneurysms of the anterior communicating artery are the most frequently encountered intracerebral aneurysms in routine neurosurgical practice. Management of intracerebral aneurysm involves aneurysm clipping or endovascular coil aneurysm embolisation. However, to the best of our knowledge, there is no reported case of an isolated ipsilateral middle cerebral artery infarction following clipping of anterior communicating artery aneurysm. Case Description: A 65-year-old female with hypertension presented with a history of giddiness, fall and altered sensorium. The patient had a Glasgow Coma Scale (GCS) score of 12, and further investigation of the magnetic resonance imaging on suspicion of stroke revealed subarachnoid haemorrhage in the bilateral parietal sulcus, left Sylvain ssure, left ambient and quadrigeminal cisterns with intra-ventricular extension. The patient was subsequently referred for neurosurgery consultation. Computed tomography (CT) angiogram conrmed the presence of a ruptured anterior communicating artery aneurysm. The neurological assessment showed reduced responsiveness to verbal commands, with a Hunt and Hess score of 3. The patient underwent uneventful clipping of the aneurysm. Postoperatively, the patient did not wake up from anaesthesia and had persistently elevated blood pressure and right-sided hemiplegia. On the third day of postoperative care, a CT head scan revealed a left middle cerebral artery infarction with a midline shift. Decompressive craniotomy was performed, and following this procedure, the patient improved in sensorium with residual right-sided hemiplegia Conclusion: This case report presents an undetected new micro embolism or postoperative cerebral vasospasm as possible causes for the development of cerebral infarct in patients with subarachnoid haemorrhage following an aneurysm rupture.

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Moyamoya: An Uncommon Variant Of Stroke In Childrena

Journal of Bahria University Medical and Dental College ◽

10.51985/jbumdc2018038 ◽

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.

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Penetrating Injury Due to Bicycle Brake Handle Causing Middle Cerebral Artery Infarct

Indian Journal of Neurotrauma ◽

10.1055/s-0039-1694295 ◽

2018 ◽

Vol 15 (02/03) ◽

pp. 067-069

Author(s):

Gopalakrishnan Madhavan Sasidharan ◽

Abhishek Chauhan

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Mass Effect ◽

Penetrating Injury ◽

Left Middle Cerebral Artery ◽

Computed Tomographic ◽

Ct Angiogram ◽

History Of ◽

Titanium Cranioplasty

AbstractAn 8-year-old boy was brought to the emergency room with history of fall from a bicycle he was riding. On examination, he had a swelling in the left orbit with a small laceration under the medial aspect of the left eyebrow. The Glasgow coma scale was E2M5V2. An emergency computed tomographic (CT) scan showed infarct causing mass effect in the territory of the left middle cerebral artery. CT angiogram showed that a branch of the middle cerebral artery was occluded at the end of track traversed by the bicycle brake handle. The patient underwent decompressive craniectomy. Initial methylmethacrylate cranioplasty had to be removed due to infection. Later, the patient underwent titanium cranioplasty. At last follow-up, he was going to school. Hemiparesis persisted. Children are vulnerable to penetrating injury by the relatively sharp brake handle when they fall from an adult bicycle. Previous reports include fatal injury by similar mechanism. In this case, it caused injury to the middle cerebral artery without causing bleed. Bicycle manufacturers could be advised to make the vehicle safer for children by twisting the end of the brake handle.

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Calcified embolus mimics patent middle cerebral artery on CT angiogram

Practical Neurology ◽

10.1136/practneurol-2017-001631 ◽

2017 ◽

Vol 17 (4) ◽

pp. 307-309 ◽

Cited By ~ 2

Author(s):

Vignan Yogendrakumar ◽

Satya Patro ◽

Dar Dowlatshahi ◽

Grant Stotts ◽

Daniela Iancu

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Ct Angiogram

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Tandem occlusion involving accessory middle cerebral artery in acute ischaemic stroke: management strategies

BMJ Case Reports ◽

10.1136/bcr-2019-233287 ◽

2020 ◽

Vol 13 (2) ◽

pp. e233287

Author(s):

Nirmalya Ray ◽

Jagadeesan Dhanasekaran ◽

Santhosh Joseph ◽

Laxmikanth Jella

Keyword(s):

Ischaemic Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Acute Ischaemic Stroke ◽

Mechanical Thrombectomy ◽

Artery Dissection ◽

Unique Challenge ◽

Ct Angiogram ◽

Tandem Occlusion ◽

Accessory Middle Cerebral Artery

Occlusion of both the limbs of accessory middle cerebral artery (AMCA) poses a unique challenge in management of acute ischaemic stroke by mechanical thrombectomy. The patient is a 30-year-old man, presenting with acute onset of left-sided hemiparesis for 4 hours. Non-contrast CT brain showed no bleed and three-dimensional CT angiogram of head and neck vessels showed dissection involving right carotid bulb and tandem occlusion of right MCA with presence of two MCA stumps. Aspiration thrombectomy was done using a reperfusion catheter, advanced separately into both the MCA stumps and complete recanalisation of both the limbs of MCAs was achieved, which was found to be AMCA. Balloon angioplasty for the internal carotid artery dissection was performed. Although occlusion of AMCA in acute ischaemic stroke is a chance occurrence, it is important to identify this variant as recanalisation of both the limbs by mechanical thrombectomy is required for favourable outcome after the procedure.

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Sensitivity of 3D gradient recalled echo susceptibility-weighted imaging technique compared to computed tomography angiography for detection of middle cerebral artery thrombus in acute stroke

Neurology International ◽

10.4081/ni.2014.5521 ◽

2014 ◽

Vol 6 (4) ◽

Cited By ~ 5

Author(s):

Amit Agarwal ◽

Kanupriya Vijay ◽

Krishnamoorthy Thamburaj ◽

Sangam Kanekar ◽

Paul Kalapos

Keyword(s):

Computed Tomography ◽

Acute Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Computed Tomography Angiography ◽

Vascular Occlusion ◽

High Sensitivity ◽

Susceptibility Weighted Imaging ◽

Diffusion Weighted Images ◽

Ct Angiogram

We aimed at comparing the sensitivity of magnetic resonance (MR) susceptibility-weighted imaging (SWI) with computed tomography angiography (CTA) in the detection of middle cerebral artery (MCA) thrombus in acute stroke. Seventy-nine patients with acute MCA stroke was selected using our search engine software; only the ones showing restricted diffusion in the MCA territory on diffusion-weighted images were included. We finally selected 35 patients who had done both MRI (including SWI) and CTA. Twenty random subjects with completely normal MRI (including SWI) exam were selected as control. Two neuroradiologists (blinded to the presence or absence of stroke) reviewed the SW images and then compared the findings with CT angiogram (in patients with stroke). The number of MCA segments showing thrombus in each patient was tabulated to estimate the thrombus burden. Thrombus was detected on SWI in one or more MCA segments in 30 out of 35 patients, on the first review. Of the 30, SWI showed thrombus in more than one MCA segments in 7 patients. CTA depicted branch occlusion in 31 cases. Thrombus was seen on both SWI and CTA in 28 patients. Thrombus was noted in two patients on SWI only, with no corresponding abnormality seen on CTA. Two patients with acute MCA showed no vascular occlusion or thrombus on either CTA or SWI. Only two case of false-positive thrombus was reported in normal control subjects. Susceptibility-weighted images had sensitivity and specificity of 86% and 90% respectively, with positive predictive value 94%. Sensitivity was 86% for SWI, compared with 89% for CTA, and this difference was statistically insignificant (P>0.05). Of all the positive cases on CTA (31) corresponding thrombus was seen on SWI in 90% of subjects (28 of 31). Susceptibility-weighted imaging has high sensitivity for detection of thrombus in acute MCA stroke. Moreover, SWI is a powerful technique for estimation of thrombus burden, which can be challenging on CTA.

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An ultrastructural analysis of the sympathetic innervation of the rabbit ear artery and middle cerebral artery and their branches

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100125075 ◽

1992 ◽

Vol 50 (1) ◽

pp. 934-935

Author(s):

John T. Dodge ◽

John A. Bevan

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Sympathetic Innervation ◽

Electrical Field Stimulation ◽

Rabbit Ear Artery ◽

Electrical Field ◽

Functional Differences ◽

Ear Artery ◽

Rabbit Ear ◽

Vascular Beds

Unlike many peripheral vascular beds, the sympathetic nervous system exerts little control on cerebral blood flow. The contractile response of isolated rabbit middle cerebral artery (MCA) segments to electrical field stimulation of its intramural nerves is less than in a similar-sized artery from the ear. This study was undertaken to characterize and compare the perivascular neuromuscular relationships and innervation density of similar-sized arteries varying in diameter from these two different regional arterial beds to see if there were structural correlates for these functional differences.

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