Xiao Wen, Hou Xiaolin, Li Dingjun, Yang Dongdong
The Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
The Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Front Neurol. 2023 Dec 20;14:1327878. doi: 10.3389/fneur.2023.1327878. eCollection 2023.
Occlusion of an intracranial arterial branch, resulting in a false positive aneurysm on vascular imaging, is extremely rare, with only a few reports in the literature and mostly in the posterior circulation artery or the middle cerebral artery (MCA) bifurcation. We report a case of a 69 years-old woman with a subacute infarct lesion in the left frontal lobe, for whom both computed tomographic angiography (CTA) and digital subtraction angiography (DSA) of the cerebral vessels showed aneurysms in the anterior segment of the M1 bifurcation of the middle cerebral artery (MCA) and in the bifurcation of the MCA. The aneurysm in the MCA bifurcation was found during craniotomy, whereas the anterior segment of the M1 bifurcation had intact branch vessels with severe atherosclerosis and no aneurysm was present. The branch vessel of M1 was presumed to be atherosclerotic occlusion resulting in the distal vessels without contrast filling on CTA and DSA, and only the occluded stump at the beginning of the vessel was filled with contrast, showing an aneurysm-like morphology, which was very confusing. This case highlights to neurologists that the diagnosis of aneurysm by cerebrovascular CTA or DSA must be carefully differentiated to avoid misdiagnosis, especially if the unruptured aneurysm is in an uncommon location in combination with ischemic cerebrovascular disease.
颅内动脉分支闭塞导致血管成像出现假阳性动脉瘤极为罕见，文献中仅有少数报道，且大多发生在后循环动脉或大脑中动脉（MCA）分叉处。我们报告一例69岁女性，左额叶有亚急性梗死灶，其脑血管计算机断层血管造影（CTA）和数字减影血管造影（DSA）均显示大脑中动脉（MCA）M1分叉前段及MCA分叉处有动脉瘤。MCA分叉处的动脉瘤在开颅手术中被发现，而M1分叉前段分支血管完整，有严重动脉粥样硬化，未发现动脉瘤。推测M1分支血管为动脉粥样硬化闭塞，导致CTA和DSA上远端血管无造影剂充盈，仅血管起始处闭塞残端有造影剂充盈，呈现动脉瘤样形态，极具迷惑性。该病例向神经科医生强调，通过脑血管CTA或DSA诊断动脉瘤时必须仔细鉴别，以避免误诊，尤其是未破裂动脉瘤位于不常见位置且合并缺血性脑血管病时。
