Abstract
Purpose
To describe a case of accessory posterior cerebral artery (PCA) [hyperplastic anterior choroidal artery (AChA)] associated with contralateral accessory middle cerebral artery (MCA) incidentally diagnosed by magnetic resonance (MR) angiography.
Methods
A 71-year-old man with paroxysmal atrial fibrillation underwent cranial MR imaging and MR angiography of the intracranial region using a 1.5-T scanner for the evaluation of brain and vascular lesions.
Results
On MR angiography, two right PCAs of equal size arose from the internal carotid artery instead of the basilar artery. Additionally, a small left MCA branch arose from the proximal A2 segment of the anterior cerebral artery (ACA).
Conclusion
One of the branches of the PCA rarely arises from the AChA. This variation is referred to as a hyperplastic AChA or accessory PCA. The latter name was recently proposed and may be more appropriate than the former name. An MCA branch arising from the ACA is called an accessory MCA. It is a frontal branch of two types: proximal-origin and distal-origin. The distal-origin accessory MCA arises from the distal A1 segment, A1–A2 junction or proximal A2 segment. Distal-origin accessory MCAs are rare. Our patient had two rare variations: an accessory right PCA and a distal-origin accessory left MCA. To identify cerebral arterial variations, especially accessory MCA, volume-rendering images are more useful than maximum-intensity projection images on MR angiography.
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References
Hahm MH, Moon S (2021) Anomalous hyperplastic anterior choroidal artery and its mimicker: a case series. Surg Radiol Anat 43:1961–1965. https://doi.org/10.1007/s00276-021-02777-8
Komiyama M, Nakajima H, Nishikawa M, Yasui T (1998) Middle cerebral artery variations: duplicated and accessory arteries. AJNR Am J Neuroradiol 19:45–49
Nishino A, Mori K, Yano Y, Koyama T, Taniwaki K, Fujita T, Taneda M (2022) An anomalous hyperplastic anterior choroidal artery associated with an unruptured internal carotid-posterior communicating artery aneurysm. Radiol Case Rep 17:1745–1749. https://doi.org/10.1016/j.radcr.2022.02.071
Nomura M, Tamase A, Kamide T, Mori K, Seki S, Iida Y (2015) Accessory middle cerebral artery associated with an unruptured aneurysm at its origin. Surg Neurol Int 6(Suppl 16):S421–S423. https://doi.org/10.4103/2152-7806.166179
Rusu MC, Vrapciu AD, Lazăr M (2023) A rare variant of accessory posterior cerebral artery. Surg Radiol Anat 45:523–526. https://doi.org/10.1007/s00276-023-03127-6
Takahashi S, Suga T, Kawata Y, Sakamoto K (1990) Anterior choroidal artery: angiographic analysis of variations and anomalies. AJNR Am J Neuroradiol 11:719–729
Uchino A, Ishihara S (2021) Type 4 persistent primitive olfactory artery associated with contralateral accessory middle cerebral artery arising from the fenestrated segment of the distal anterior cerebral artery. Surg Radiol Anat 43:1951–1953. https://doi.org/10.1007/s00276-021-02831-5
Uchino A, Kamide T, Kurita H (2019) Replaced posterior cerebral artery (PCA): origin of all branches of the PCA from the anterior choroidal artery diagnosed by MR angiography. Surg Radiol Anat 41:703–705. https://doi.org/10.1007/s00276-019-02209-8
Uchino A, Kato A, Takase Y, Kudo S (2000) Middle cerebral artery variations detected by magnetic resonance angiography. Eur Radiol 10:560–563. https://doi.org/10.1007/s003300050960
Uchino A, Nakadate M (2022) Multiple cerebral arterial variations incidentally detected by magnetic resonance angiography: a case report. Surg Radiol Anat 44:411–414. https://doi.org/10.1007/s00276-022-02891-1
Uchino A, Saito N, Takahashi M, Okano N, Tanisaka M (2016) Variations of the posterior cerebral artery diagnosed by MR angiography at 3 tesla. Neuroradiology 58:141–146. https://doi.org/10.1007/s00234-015-1614-5
Zhang Z, Liu Z, Peng D (2019) Transient global amnesia secondary to atherosclerotic stenosis of accessory posterior cerebral artery. J Stroke Cerebrovasc Dis 28:e22–e23. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.12.046
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AU designed the study and drafted the manuscript. AU and TI critically reviewed the manuscript and read and approved the final manuscript.
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Uchino, A., Irie, T. Accessory posterior cerebral artery (hyperplastic anterior choroidal artery) associated with contralateral accessory middle cerebral artery incidentally diagnosed by magnetic resonance angiography. Surg Radiol Anat 46, 313–316 (2024). https://doi.org/10.1007/s00276-024-03298-w
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DOI: https://doi.org/10.1007/s00276-024-03298-w