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Aplastic or Twig-Like Middle Cerebral Artery Presenting with Intracerebral Hemorrhage During Pregnancy: Report of Two Cases
Akihiko Hino,Hideki Oka,Hiroyuki Yamamoto,Masataka Nanto,Naoto Shiomi,Naoya Hashimoto,Shiho Hiraizumi,Sho Nishii,Takanari Okamoto,Takumi Yamanaka,Yudai Goto
- , 2019, DOI: 10.1016/j.wnsx.2019.100018
Abstract: An aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare congenital anomaly that can present with both ischemic and hemorrhagic stroke. The etiology of this pathology has remained unclear. Here, we report 2 cases of intracerebral hemorrhage (ICH) owing to an Ap/T-MCA in pregnant patients
Unruptured Aneurysm at the Origin of the Duplicated Middle Cerebral Artery Treated by Coil Embolization: A Case Report  [PDF]
Shingo Toyota, Tetsuya Kumagai, Hirofumi Sugano, Shota Yamamoto, Kanji Mori, Takuyu Taki
Open Journal of Modern Neurosurgery (OJMN) , 2015, DOI: 10.4236/ojmn.2015.51005
Abstract: Aneurysm at the origin of a duplication of the middle cerebral artery (DMCA) is very rare, and only 29 treated cases have been reported. All of the cases were treated by direct surgery except a ruptured case treated by intentional partial coil embolization. We report the first unruptured case treated by coil embolization and review the previously published cases. Coil embolization can be alternative treatment for an unruptured aneurysm at the origin of the DMCA. Stable framing to spare the origin of it and prevention of thromboembolic complications are keys for safe treatment.
From Awake Carotid Occlusion to Saphenous-Vein High-Flow Bypass: Surgical Solutions for Complex Intracranial Aneurysms in a New  [PDF]
Nassourou Oumarou Haman, Ngbwa Ghislain Guea, Ronaldo Fonju Anu, Assiga Yves Martin Ahanda, Petridis Athanasios, Vincent de Paul Djientcheu
Open Journal of Modern Neurosurgery (OJMN) , 2026, DOI: 10.4236/ojmn.2026.162020
Abstract: Background and Importance: The re-establishment of an on-site cerebrovascular fellowship in Cameroon enabled progressively more advanced open and hybrid treatments for complex intracranial aneurysms, including giant lesions and aneurysms associated with vasculopathy. In environments where endovascular resources are limited, extracranial-intracranial (EC-IC) bypass remains an essential technique to preserve or restore cerebral perfusion when parent-artery sacrifice or trapping is required. Clinical Cases: We report two illustrative cases in which EC-IC bypass was central to definitive management. Case 1: a 60-year-old woman with a symptomatic, giant cavernous internal carotid artery (ICA) aneurysm presenting with oculomotor palsy. The aneurysm was initially treated with distal ICA occlusion under awake anesthesia and appeared controlled; months later, the patient developed contralateral upper-extremity weakness and visual disturbance consistent with hypoperfusion. She subsequently underwent a high-flow CCA → saphenous-vein graft → M2 bypass with clinical improvement. Case 2: a 43-year-old man with subarachnoid hemorrhage from a wide-neck right M1-M2 aneurysm underwent a protective low-flow STA → M4 MCA bypass prior to definitive microsurgical clipping; trapping proved unnecessary and the patient recovered without neurologic deficit. Conclusions and Implications: EC-IC bypass techniques can be safely and effectively implemented in resource-limited cerebrovascular programs when teams are trained, basic microsurgical infrastructure is available, and perioperative systems are in place. These cases support strategic capacity-building—progressive skill development (STA-MCA → interposition grafts), targeted equipment investment, and rehabilitation pathways—to expand durable treatment options for complex aneurysms where endovascular solutions are unavailable or unsuitable.
Intracerebral Hemorrhage Secondary to Chronic Left Middle Cerebral Artery Occlusion: Diagnostic Challenges and Clinical Implications  [PDF]
Tarsila Stockler Ravaschieri Martinolli, Daniel Gurgel Fernandes Távora, Francisco Barbosa de Araújo Neto, Dárvylla de Sousa Lima, Matheus Cardoso Arag？o, Antonio Victor Gouveia Azevedo dos Santos, Rafael de Oliveira Sousa, Jo？o Vitor Lopes Montes, Rodolfo Ebert de Oliveira Garcia
Open Journal of Medical Imaging (OJMI) , 2025, DOI: 10.4236/ojmi.2025.154019
Abstract: Intracerebral Hemorrhage (ICH) is a severe form of stroke with high morbidity and mortality. While Middle Cerebral Artery (MCA) occlusion typically results in ischemic infarction, ICH secondary to chronic MCA occlusion without concomitant ischemia is an exceedingly rare phenomenon that challenges both diagnosis and management. We report a 45-year-old male with multiple cardiovascular risk factors presenting with acute focal neurological deficit, which emphasizes the importance of considering chronic MCA occlusion as a potential etiology of ICH, even in the absence of infarction. Radiological evaluation, especially with magnetic resonance imaging, is essential to guide prevention and management strategies.
Superficial Temporal Artery to Middle Cerebral Artery Bypass and Endovascular Parent Artery Occlusion in the Treatment of Giant Intracranial Aneurysms  [PDF]
Aurélien Ndoumbe, Aimée Redondo
Open Journal of Modern Neurosurgery (OJMN) , 2018, DOI: 10.4236/ojmn.2018.82013
Abstract: The authors are reporting on a study drawn from unpublished dissertation done by the corresponding author when he completed his neurosurgical training in Paris, France in 2004, few years before the advent of flow diverters. The study was a retrospective review of giant intracranial aneurysms treated by superficial temporal artery to middle cerebral artery bypass combined with endovascular occlusion of the parent artery. From 1990 to 2003, 29 consecutive cases of giant cerebral aneurysms, not suitable to selective treatment were managed in that way. Twenty-one medical records had enough data to allow objective evaluation. Sixteen female and five male patients bearing 21 giant aneurysms were involved. Their mean age was 46 years. The aneurysm was revealed by mass effect in 13 cases and subarachnoid hemorrhage in one case. On admission 19 patients presented with unruptured aneurysms and two have sustained a subarachnoid hemorrhage. The balloon occlusion test before the bypass operation was not tolerated in 18 patients. The treatment was completed in 19 patients and 17 of them had parent artery occlusion with latex detachable balloons. The only death of the series occurred before the endovascular treatment. The mean follow-up period was 30 months. After completion of the treatment, 16 (84%) patients had no symptom. Aneurysm recanalization or rupture was not observed after the parent artery occlusion. With the combination of superficial temporal artery to middle cerebral artery bypass + endovascular parent artery occlusion, 90% of giant intracranial aneurysms untreatable selectively were permanently excluded with a good outcome in 95%.
Anomalies, Aneurysm and Histology of the Middle Cerebral Artery in Nigerian Africans
Idowu,O. E; Shokunbi,M.T; Malomo,A. O; Akang,E. E. U;
International Journal of Morphology , 2008, DOI: 10.4067/S0717-95022008000400038
Abstract: the histology of the middle cerebral artery (mca) in nigerian africans has not been previously studied. one hundred mcas obtained at autopsy from fifty adult nigerians were studied. the vessels were processed and stained with ehrlich's haematoxylin and eosin, elastic van gieson and masson's trichrome stains. early branches were given off before the perforators in two middle cerebral arteries, and there was one accessory mca, making an incidence of anomalies of 3%. no aneurysm was observed in any of the cases. the internal elastic laminas were well developed but the external elastic laminas of the vessels were poorly developed. cióse to the bif urcations the túnica media tapered gradually and at the bif urcations, the túnica media was completely deficient being replaced by the túnica adventitia (forbus raphé). the túnica adventitia was thicker at the bifurcations (0.21mm) compared to other sites of the vessel. the average thickness of the mca túnica media atits origin was 0.12mm while thatof the túnica adventitia was o.lomm. theseresults are similar to what has been described in the literature for caucasians. it buttresses the assertion that anatomical anomalies of the mca are rare. the seemingly low frequency of mca aneurysms in nigerian africans is not due to its anomalies or histology.
Benefits of Hemicraniectomy Seen Many Years After Malignant Stroke in a Young Patient
Anupam Mittal,Geetanjli Mittal,Arthur Partikian,David Liebeskind,Nerses Sanossian
Frontiers in Neurology , 2012, DOI: 10.3389/fneur.2012.00123
Abstract: The benefits of hemicraniectomy for malignant middle cerebral artery (MCA) stroke may not be apparent in the 3- to 6-months in which final outcomes are assessed in research studies. We present the case of a 15-year-old who underwent hemicraniectomy for malignant MCA stroke and was significantly disabled 3 and 6 months after event. Over the long-term she was able to graduate from university, play tennis, and live an independent life. Although functional independence with only minor disability is relatively rare in adult hemicraniectomy patients, this outcome may be more easily achieved in children during a longer period of follow-up.
Middle Cerebral Artery Stenosis Associated with Moyamoya Pattern Collateralization
Randall C. Edgell,Alan S. Boulos,Afshin Borhani Haghighi,Gary L. Bernardini,Dileep R. Yavagal
Frontiers in Neurology , 2010, DOI: 10.3389/fneur.2010.00119
Abstract: Background and Purpose: Moyamoya disease is a well described phenomenon. This pattern of collateralization associated with isolated middle cerebral artery stenosis and the natural history of this entity have not been well described. Methods: Cerebral angiograms and CT angiograms performed between August 2004 and August of 2006 demonstrating moyamoya collateralization were retrospectively reviewed. All cases of middle cerebral artery stenosis associated with a rete pattern of collateralization were included in this series. Demographic, clinical, and angiographic data were obtained. Results: There were three cases of middle cerebral artery stenosis associated with a moyamoya pattern of collateralization. The average age of the patients was 36-years old, 2 were male, and all were Caucasian. All patients presented with ischemic symptoms. The average degree of stenosis was 91%. No stenosis was seen in the supraclinoid internal carotid arteries or elsewhere in the intracranial vasculature. Conclusion: We describe an unusual pattern of anastomosis associated with isolated severe middle cerebral artery stenosis or occlusion in Caucasians.
Association Between Duration of Dysphagia Recovery and Lesion Location on Magnetic Resonance Imaging in Patients With Middle Cerebral Artery Infarction
Dung Gyu Kim,Ghi Chan Kim,Ho Joong Jeong,Jae Ho Kim,Se Hyun Oh,Young Joo Sim
- , 2019, DOI: 10.5535/arm.2019.43.2.142
Abstract: To investigate association between lesion location on magnetic resonance imaging (MRI) performed after an infarction and the duration of dysphagia in middle cerebral artery (MCA) infarction
胎孕20~36周胎儿多动脉血流动力学参数演变规律及临床应用探索
Evolution and Clinical Application of Fetal Polyarterial Hemodynamic Parameters in 20~36 Weeks of Gestation  [PDF]
尚伟, 闫国珍, 原志强, 白彦, 李明娟
Advances in Clinical Medicine (ACM) , 2026, DOI: 10.12677/acm.2026.161070
Abstract: 目的：测定孕20~36周孕妇UtA、UA、RA、MCA的血流动力学参数，研究此孕期UtA、UA、RA、MCA血流演变规律及临床应用探索。方法：彩色多普勒血流动力学分别测量200例孕20~36周孕妇UtA及胎儿UA、RA、MCA的PSV、EDV、RI、PI、S/D。结果：胎儿生长发育过程中UA、MCA和RA的PSV与孕周呈正相关，孕妇UtA的PSV随着孕周增加无明显改变；胎儿UA、MCA、RA、孕妇UtA的EDV与孕周呈正相关；胎儿UA、RA、孕妇UtA的RI、PI、S/D与孕周呈负相关，且组间呈正相关；胎儿MCA的RI、PI、S/D随着孕周的增加呈现先上升后下降的趋势；胎儿MCA、UA、RA、孕妇UtA的RI、PI、S/D的组间差异具有统计学意义(P < 0.01)。结论：在20~32周，UA血流参数变化为：S/D由3.40 ± 0.54逐渐下降至2.47 ± 0.53，RI由0.70 ± 0.05下降至0.58 ± 0.08，PI由1.16 ± 0.14下降至0.87 ± 0.19。MCA的S/D始终保持在3.0以上，RI保持在0.7以上，PI保持在1.2以上，并呈现出先上升后下降的规律。UtA血流参数变化为：S/D由2.34 ± 0.89下降至1.84 ± 0.26，RI由0.53 ± 0.12下降至0.44 ± 0.07，PI由0.91 ± 0.42下降至0.64 ± 0.16。RA血流参数变化为：S/D由8.38 ± 2.41下降至7.04 ± 2.34，RI由0.87 ± 0.04下降至0.84 ± 0.04，PI由2.21 ± 0.31下降至1.87 ± 0.40。且RA的RI、PI、S/D处于最高水平，UtA的RI、PI、S/D处于最低水平，MCA的的RI、PI、S/D高于UA。本文数据可用作多参数超声监测胎儿宫内发育情况的参考。
Objective: The hemodynamic parameters of UtA, UA, RA, and MCA in pregnant women from 20 to 36 weeks of gestation were determined, and the blood flow evolution rules of UtA, UA, RA, and MCA and its clinical application were explored. Methods: PSV, EDV, RI, PI and S/D of UtA and fetal UA, RA and MCA were measured by color Doppler hemodynamics in 200 pregnant women at 20~36 weeks. Results: The PSV of UA, MCA and RA were positively correlated with gestational age during fetal growth and development. The PSV of UtA did not change with gestational age. The EDV of fetal UA, MCA, RA and UtA were positively correlated with gestational age. The RI, PI and S/D of fetal UA, RA and UtA in pregnant women were negatively correlated with gestational age, and positively correlated with each other. The RI, PI and S/D of fetal MCA increased first and then decreased with the increase of gestational age. There were significant differences in MCA, UA, RA of fetus and RI, PI, S/D of UtA of pregnant women (P < 0.01). Conclusion: During 20~32 weeks, UA blood flow parameters decreased from 3.40 ± 0.54 to 2.47 ± 0.53, RI from 0.70 ± 0.05 to 0.58 ± 0.08, PI from 1.16 ± 0.14 to 0.87 ± 0.19. MCA S/D is always above 3.0, RI is above 0.7, PI is above 1.2, and it shows a law of first rising and then falling. UtA blood flow parameters decreased from 2.34 ± 0.89 to 1.84 ± 0.26, RI from 0.53 ± 0.12 to 0.44 ± 0.07, PI from 0.91 ± 0.42 to 0.64 ± 0.16. RA blood flow
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