Rene Viso1, Ivan Lylyk1, Pablo Albiña2,3, Javier Lundquist1, Esteban Scrivano1, Pedro Lylyk1. 1. Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina. 2. Departamento de Neurocirugía, Hospital Barros Luco Trudeau, Santiago, Chile. 3. Departamento de Anatomía, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Abstract
INTRODUCTION: Twig-like middle cerebral artery configuration (Tw-MCA) is a rare and commonly misdiagnosed vascular anomaly characterized by a plexiform arterial network that replaces the normal M1 segment. The prevalence and clinical relevance of this anomaly is not fully established. MATERIAL AND METHODS: We sought to explore the prevalence of Tw-MCA in patients clinically referred to digital angiography in a single academic comprehensive endovascular center and evaluated the radiological and clinical findings among patients with hemorrhagic events. RESULTS: From 2011 to 2020, a total of 10,234 patients underwent a cerebral angiography at our institution. During this period, 9 (0.088%) Tw-MCAs were identified. Out of these, 5 patients (62.5%) were admitted due to an intracranial hemorrhage. Two patients had a ruptured intracranial aneurysm on the anterior communicating artery, one with multiple brain aneurysms; two patients presented an intraparenchymal hematoma (IPH) due to the presence of a periventricular anastomosis and one patient an intraventricular hemorrhage with unclear origin. CONCLUSION: Tw-MCA is a very rare vascular anomaly associated with hemorrhagic events. Adequate identification of this anomaly is essential in order to avoid misdiagnosis as steno-occlusive disorders.
INTRODUCTION: Twig-like middle cerebral artery configuration (Tw-MCA) is a rare and commonly misdiagnosed vascular anomaly characterized by a plexiform arterial network that replaces the normal M1 segment. The prevalence and clinical relevance of this anomaly is not fully established. MATERIAL AND METHODS: We sought to explore the prevalence of Tw-MCA in patients clinically referred to digital angiography in a single academic comprehensive endovascular center and evaluated the radiological and clinical findings among patients with hemorrhagic events. RESULTS: From 2011 to 2020, a total of 10,234 patients underwent a cerebral angiography at our institution. During this period, 9 (0.088%) Tw-MCAs were identified. Out of these, 5 patients (62.5%) were admitted due to an intracranial hemorrhage. Two patients had a ruptured intracranial aneurysm on the anterior communicating artery, one with multiple brain aneurysms; two patients presented an intraparenchymal hematoma (IPH) due to the presence of a periventricular anastomosis and one patient an intraventricular hemorrhage with unclear origin. CONCLUSION: Tw-MCA is a very rare vascular anomaly associated with hemorrhagic events. Adequate identification of this anomaly is essential in order to avoid misdiagnosis as steno-occlusive disorders.
Authors: Philippe Gailloud; Sait Albayram; Jean H D Fasel; Norman J Beauchamp; Kieran J Murphy Journal: AJNR Am J Neuroradiol Date: 2002-04 Impact factor: 3.825