Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, Reggio Emilia, 42123, Italy.
Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, Reggio Emilia, 42123, Italy.
Surg Radiol Anat. 2024 Nov 29;47(1):10. doi: 10.1007/s00276-024-03525-4.
Middle cerebral artery (MCA) anomalies are a small group of congenital variants, including fenestration, duplication and Twig-like MCA. Some other variants, i.e. in the branching pattern, have been described independently from the previous ones, but their association might raise an embryological reasoning.
We are presenting an incidental finding in a patient undergoing brain Magnetic Resonance Imaging (MRI) and Angiography (MRA) for episodic headache, i.e. right MCA fenestration and left MCA very early branching. The patient was investigated only by MRA, being the finding incidental and non-pathological. Among the intracranial arteries, MCA has a lower rate of fenestrations and several embryological hypotheses have been proposed, different from the presumed mechanisms underlying vertebral and basilar artery fenestrations. Both fenestration and early branching in MCA in our case might resemble to a partial MCA duplication with proximal and distal fusion in the first and only a proximal fusion in the second one. The pattern of distribution of the early branches in the left MCA territory may support this view, together with the lenticulostriate perforating arteries origin.
The association of several MCA anomalies, as fenestration and early branching, might have a common genesis within the same embryological period.
大脑中动脉（MCA）异常是一小部分先天性变异，包括窗孔、重复和树枝状 MCA。其他一些分支模式的变异已经独立于之前的变异被描述，但它们的关联可能会引发胚胎学上的推理。
我们报告了一名患者的偶然发现，该患者因间歇性头痛接受脑磁共振成像（MRI）和血管造影（MRA）检查，即右侧 MCA 窗孔和左侧 MCA 早期分支。该患者仅接受了 MRA 检查，该发现是偶然的且非病理性的。在颅内动脉中，MCA 的窗孔发生率较低，已经提出了几种胚胎学假说，与椎动脉和基底动脉窗孔的假定机制不同。在我们的病例中，MCA 的窗孔和早期分支可能类似于部分 MCA 重复，在第一个分支中近端和远端融合，而在第二个分支中仅近端融合。左侧 MCA 区域早期分支的分布模式可能支持这种观点，与纹状体穿通动脉的起源有关。
MCA 异常（如窗孔和早期分支）的多种情况可能具有相同的胚胎学起源。
