Twig-like Middle Cerebral Artery: clinical image

Resumo

A artéria cerebral média em padrão Twig-like é uma anomalia vascular rara, caracterizada por uma rede plexiforme de pequenos vasos substituindo o segmento M1 da artéria cerebral média, frequentemente confundida com a doença de Moyamoya. Relatamos uma mulher de 30 anos sem problemas de saúde notáveis que apresentou dores de cabeça persistentes acompanhadas de distúrbios visuais. Estudos de imagem, incluindo ressonância magnética (RM) e angio-RM, revelaram uma configuração vascular intrincada na região do M1 esquerdo, com preenchimento inadequado em segmentos posteriores. A angiografia cerebral subsequente confirmou a presença de uma rede de pequenos vasos na área do M1 da artéria cerebral média esquerda. Embora o fluxo sanguíneo estivesse mais lento nas áreas distais, mecanismos compensatórios através de conexões leptomeníngeas aliviaram potenciais problemas circulatórios. A condição aparentemente era de natureza congênita e a paciente recebeu alta após um manejo eficaz da dor para acompanhamento. É crucial distinguir a artéria cerebral média em padrão Twig-like da doença de Moyamoya devido às suas características angiográficas contrastantes, ressaltando a importância para os neurorradiologistas reconhecerem tais anomalias para evitar diagnósticos errôneos e garantir o tratamento adequado.

Palavras-chave

Artéria cerebral média; Padrão Twig-like; Doença de Moyamoya; Embriologia; Anomalia vascular

Abstract

The twig-like middle cerebral artery (MCA-T) is a rare vascular anomaly characterized by a plexiform network of small vessels replacing the M1 segment of the middle cerebral artery (MCA), often misdiagnosed as Moyamoya disease (MMD). This report describes a 30-year-old woman with no notable medical history who presented with persistent headaches and visual disturbances. Imaging studies, including magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), revealed an intricate vascular configuration in the left M1 region of the MCA with inadequate filling of distal segments. Cerebral angiography confirmed a network of small vessels in the M1 segment of the left MCA. Although slower blood flow was noted in the distal MCA territory, compensatory leptomeningeal anastomoses prevented significant hemodynamic compromise. The anomaly appeared to be congenital, and the patient was discharged with effective pain management and scheduled for follow-up care. Differentiating MCA-T from MMD is essential due to their distinct angiographic characteristics, underscoring the need for neuroradiologists to accurately identify these anomalies to prevent misdiagnosis and ensure appropriate treatment.

Keywords

Middle cerebral artery; Twig-like MCA; Moyamoya disease; Embryology; Vascular anomaly

References

1. Goto Y, Oka H, Hiraizumi S, et al. Aplastic or Twig-Like middle cerebral artery presenting with intracerebral hemorrhage during pregnancy: report of two cases. World Neurosurg X. 2019;2:100018. http://doi.org/10.1016/j.wnsx.2019.100018. PMid:31218292.

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3. Viso R, Lylyk I, Albiña P, Lundquist J, Scrivano E, Lylyk P. Hemorrhagic events associated with unfused or twig-like configuration of the middle cerebral artery: a rare vascular anomaly with clinical relevance. Interv Neuroradiol. 2021;27(2):285-90. http://doi. org/10.1177/1591019920970430. PMid:33121291.

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Twig-like Middle Cerebral Artery: clinical image

Artéria Cerebral Média Em Padrão Twig-Like: imagem clínica

Resumo

Palavras-chave

Abstract

Keywords

References

JBNC Brazilian Journal of Neurosurgery

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