MRA, CTA and three-dimensional rotational angiography of incidentally detected bilateral accessory middle cerebral arteries

Abstract

Purpose: The accessory middle cerebral artery and duplicated middle cerebral artery are anomalous, extremely rare and detected incidentally. While almost all cases where they are detected are unilateral, bilateral cases are extremely rare with only a few case reports.

Methods: We report a case of incidentally detected bilateral accessory middle cerebral arteries (AMCAs) on imaging findings at our hospital with a review of previous reports.

Case report and results: A sixty-year-old woman was brought to our hospital with right upper and lower extremity paralysis and dysarthria. Magnetic resonance imaging scan of the head showed cerebral infarction from the left putamen to the corona radiata and bilateral AMCAs on magnetic resonance angiography. We performed cerebral angiography and CT angiography to evaluate the vessels and obtained detailed imaging findings. The bilateral AMCAs were symmetrically located, both branching from the distal part of A1, and were type 3 according to Manelfe's classification. We reviewed the literature on bilateral AMCAs and found seven similar cases. The age, gender, and pathology varied widely, and the location of the bifurcation was symmetrical in six of the seven cases.

Conclusion: We found bilateral AMCAs incidentally in a cerebral infarction that occurred in a sixty-year-old woman. We should consider the presence of abnormal vessels when treating cerebrovascular diseases.

Keywords: Accessory middle cerebral artery; Anatomy; Anomaly; Bilateral; Cerebral arterial variation.