Unusual hemodynamic stroke related to an accessory middle cerebral artery: The usefulness of fusion images from three-dimensional angiography.
BACKGROUND
Ischemic stroke associated with an anomaly of the middle cerebral artery (MCA) is a rare occurrence. The diagnosis is very difficult when there are steno-occlusive lesions associated with an accessory middle cerebral artery (AMCA).


METHODS
A 77-year-old female with hypertension and hyperlipidemia experienced repeated transient ischemic attacks (TIAs) of motor aphasia and dysarthria. Although angiography showed only left intracranial occlusion, the fusion images of three-dimensional digital subtraction angiography (3-D DSA) showed complex steno-occlusive lesions and an AMCA related with the TIA. The cerebral blood flow (CBF) to the left frontal lobe was supplied by the AMCA, via the anterior communicating artery from the right internal carotid artery. The left temporal and parietal lobes were supplied by the stenotic MCA, via the left posterior communicating artery from the left posterior cerebral artery. Single-photon emission computed tomography showed a marked decrease in CBF to both the left frontal and temporal lobes. A left superficial temporal artery (STA)-to-left MCA double anastomosis was performed, in which each branch of the STA supplied branches of the AMCA and MCA.


CONCLUSIONS
This is the first reported case of ischemic stroke in a patient with an AMCA. The exact diagnosis could be made only by using fusion images of 3-D DSA, which were useful for understanding the complicated CBF pattern and for the choice of recipient artery in bypass surgery.
Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
Kei
K
Noguchi
Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
Takachika
T
Aoki
Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
Satoru
S
Komaki
Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
Yasuharu
Y
Takeuchi
Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
Masaru
M
Hirohata
Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
Motohiro
M
Morioka
3D-DSA; Accessory middle cerebral artery; revascularisation; transient ischemic attack