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Azygos anterior cerebral artery

Dr Owen Kang ◉ and A.Prof Frank Gaillard ◉ ◈ et al.

An azygos anterior cerebral artery is an uncommon to rare variant of the circle of Willis where the two A1 segments of the anterior cerebral artery (ACA) join to form a single trunk. As a result, there is no anterior communicating artery. This organization is similar to that seen in lower primates ².

Epidemiology

They are present in approximately 0.4-1% of the population ¹.

Pathology

Associations

It is associated with numerous abnormalities, including ¹:

Berry aneurysms are often seen at the eventual bifurcation of the single vessel, due to either altered hemodynamics or congenitally abnormal wall, or both. The reported incidence varies widely, from 13 to 71% ¹.

As there is frequent hypoplasia of the anterior communicating artery and supply of the medial surface of the hemispheres by contralateral ACA branches, confirmation of an azygos ACA can be difficult on angiography ². Cross compression views can be helpful.

References

Anatomy: Brain

brain
- grey matter
- white matter
- cerebrum
  - cerebral hemisphere (telencephalon)
  - white matter tracts
  - deep grey matter
    - basal ganglia
      claustrum
  - pituitary gland
    - posterior pituitary and stalk (part of diencephalon)
      - ectopic posterior pituitary
    - anterior pituitary
    - inferior hypophyseal arterial circle
  - diencephalon
    - thalamencephalon
    - subthalamus
      - subthalamic nuclei
    - hypothalamus
- brainstem
  - midbrain (mesencephalon)
  - pons (part of metencephalon)
    - facial colliculus
    - superior olivary nucleus
  - medulla oblongata (myelencephalon)
    - olive
    - inferior olivary nucleus
  - white matter
  - grey matter (non-cranial nerve)
- cerebellum (part of metencephalon)
  - vermis
  - cerebellar hemisphere
    - cerebellar tonsil
    - dentate nucleus
  - cerebellar peduncles
- cranial meninges (meninx primitiva)
- CSF spaces
  - ventricular system
  - subarachnoid cisterns
- cranial nerves (mnemonic)
  - olfactory nerve (CN I)
  - optic nerve (CN II)
    - optic chiasm
    - optic tract
  - oculomotor nerve (CN III)
  - trochlear nerve (CN IV)
  - trigeminal nerve (CN V) (mnemonic)
  - abducens nerve (CN VI)
  - facial nerve (CN VII) (segments mnemonic | branches mnemonic)
    - geniculate ganglion
    - nervus intermedius
  - vestibulocochlear nerve (CN VIII)
  - glossopharyngeal nerve (CN IX)
    - Jacobson nerve
  - vagus nerve (CN X)
    - Arnold's nerve
  - spinal accessory nerve (CN XI)
  - hypoglossal nerve (CN XII)
- functional neuroanatomy
  - Brodmann areas
  - cortical motor system
    - extrapyramidal system
  - cortical sensory system
    - pain and temperature sensation
    - vibration and proprioception sensation
  - auditory/speech system
    - Broca's area (Brodmann area 44)
    - Wernicke's area (Brodmann area 22)
  - visual system
  - olfactory system
- CNS development
  - brain development
- cerebral vascular supply
  - arteries
    - vascular territories
    - circle of Willis
      - internal carotid artery (ICA) (segments)
        
        inferolateral trunk
        
        meningohypophyseal trunk
        inferior hypophyseal artery
        
        capsular arteries (of McConnell) (variable)
        
        superior hypophyseal artery
        
        anterior cerebral artery (ACA)
        
        anterior communicating artery (ACOM)
        
        medial lenticulostriate arteries
        
        recurrent artery of Heubner
        
        medial frontobasal artery
        
        frontopolar artery
        
        orbitofrontal artery
        
        pericallosal artery
        
        callosomarginal artery
        
        pericallosal moustache
        
        middle cerebral artery (MCA)
        
        M1 branches
        
        lenticulostriate arteries
        
        medial lenticulostriate arteries
        
        lateral lenticulostriate arteries
        
        anterior temporal artery
        
        temporopolar artery
        
        M2 branches
        
        posterior communicating artery (PCOM)
        
        ophthalmic artery
        
        lacrimal artery
        
        supraorbital artery
        
        posterior ethmoidal artery
        
        anterior ethmoidal artery
        
        internal palpebral artery
        
        supratrochlear artery (frontal artery)
        
        dorsal nasal artery
        
        anterior choroidal artery
      - vertebral artery
        
        posterior inferior cerebellar artery (PICA)
        
        basilar artery
        
        anterior inferior cerebellar artery (AICA)
        labyrinthine artery
        
        pontine arteries
        
        superior cerebellar artery (SCA)
        
        posterior cerebral artery (PCA)
        
        calcarine artery
        
        splenial artery
        
        posterior choroidal artery
        
        medial posterior choroidal artery
        
        lateral posterior choroidal artery
      - normal variants
        
        intracranial arterial fenestration
        
        internal carotid artery (ICA)
        
        absent ICA
        
        aberrant ICA
        
        anterior cerebral artery (ACA)
        azygos ACA
        
        middle cerebral artery (MCA)
        
        accessory MCA
        
        duplicated MCA
        
        MCA fenestration
        
        posterior cerebral artery (PCA)
        
        fetal origin of PCA / fetal PCOM
        
        artery of Percheron
        
        basilar artery
        
        basilar artery fenestration
        
        basilar artery hypoplasia
        
        persistent carotid-vertebrobasilar artery anastomoses (mnemonic)
        
        persistent primitive trigeminal artery
        
        persistent otic artery
        
        persistent hypoglossal artery
        
        persistent proatlantal artery
        
        persistent proatlantal intersegmental artery
        
        posterior cerebral circulation
  - cerebral venous system
    - dural venous sinuses
    - cerebral veins
      - superficial veins of the brain
        
        superior cerebral veins (superficial cerebral veins)
        
        inferior cerebral veins
        
        superficial middle cerebral vein
        
        superior anastomotic vein (of Trolard)
        
        inferior anastomotic vein (of Labbe)
    - deep veins of the brain
    - normal variants
      - persistent falcine sinus
- glymphatic pathway

Article information

rID: 6656

System: Vascular, Central Nervous System

Section: Anatomy

Synonyms or Alternate Spellings:

Azygous anterior cerebral artery
Azygous ACA
Azygos ACA

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Cases and figures

Figure 1: azygos ACAFigure 1: azygos ACA

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Case 1Case 1

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Figure 2: conventional ACA anatomyFigure 2: conventional ACA anatomy

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Case 2: septooptic dysplasiaCase 2: septooptic dysplasia

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Ribbon lipoma wit...

Case 3: corpus callosal dysgenesis and lipomaCase 3: corpus callosal dysgenesis and lipoma

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Case 4: syntelencephalyCase 4: syntelencephaly

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Case 5Case 5

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Case 6Case 6

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Case 7Case 7

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