Wang Kai-Meng, Xie Yan-Zhao, Xu Guo-Dong, Yao Wentao, Wang He-Bo
The Neurology Department of Hebei Provincial People's Hospital, Shijiazhuang, Hebei, China.
The Neurointervention Department of Hebei Provincial People's Hospital, Shijiazhuang, Hebei, China.
Front Cardiovasc Med. 2025 Mar 11;12:1530241. doi: 10.3389/fcvm.2025.1530241. eCollection 2025.
Twig-like middle cerebral artery (T-MCA) is a rare cerebrovascular malformation with an incidence of approximately 0.11% to 1.17%. It is challenging to distinguish T-MCA from Moyamoya Angiopathy (MMA), particularly from unilateral MMA.
A middle-aged female patient was admitted to our hospital for diagnosis and treatment due to intermittent dizziness lasting for two months. Neurological examination upon admission revealed no significant abnormalities.Whole-brain angiography showed clear blood flow in the left common carotid artery and internal carotid artery; however, no main trunk of the distal left middle cerebral artery M1 segment was visualized, and a network of small arteries supplying blood was observed. High-resolution intracranial arterial plaque imaging revealed no visualization of the LM1 main trunk on plain scan or enhanced high-resolution black-blood sequence; the proximal segment showed significant narrowing with circumferential thickening of the vessel wall. The patient was ultimately diagnosed with left-sided T-MCA.
Asymptomatic T-MCA is challenging to identify clinically, making it essential to perform DSA or high-resolution MRI for suspected cases promptly. Regular follow-up is also necessary to confirm the final diagnosis in these patients.
树枝状大脑中动脉（T-MCA）是一种罕见的脑血管畸形，发病率约为0.11%至1.17%。将T-MCA与烟雾病（MMA）区分开来具有挑战性，尤其是与单侧MMA区分。
一名中年女性患者因持续两个月的间歇性头晕入院接受诊断和治疗。入院时神经检查未发现明显异常。全脑血管造影显示左侧颈总动脉和颈内动脉血流清晰；然而，未见到左侧大脑中动脉M1段的主干，观察到一个供血的小动脉网络。高分辨率颅内动脉斑块成像在平扫或增强高分辨率黑血序列上均未见到LM1主干；近端节段显示明显狭窄，血管壁周向增厚。该患者最终被诊断为左侧T-MCA。
无症状性T-MCA在临床上难以识别，因此对于疑似病例及时进行DSA或高分辨率MRI检查至关重要。对这些患者进行定期随访以确诊也很有必要。
