MCA trifurcation aneurysm (CTA)

Case contributed by Dr Roberto Schubert

Presentation

CT performed for possible ischaemic stroke and acute headaches.

Patient Data

Age: 70
Gender: Male
CT

CT brain

Non contrast CT scan through the brain demonstrates no acute abnormality. Extensive periventricular low density is in keeping with small vessel ischaemic change, most likely chronic. On the right a rounded density is seen in the sylvian fissure, which appears to be in continuity with the right MCA and contains a focus of peripheral calcification. The supraclinoid ICA on the left is bulbous. No evidence of subarachnoid haemorrhage. 

CT

CT angiogram

Large aneurysm at the branching M1 segment of the right middle cerebral artery, giving off superior middle and inferior vessels (MCA trifurcation). No signs of recent haemorrhage. The left supraclinoid internal carotid artery is ectatic, incorporating the origin of the PCOM, but no focal aneurysm can be identified. 

Case Discussion

An aneurysm is a focal abnormal dilatation of a blood vessel. Cerebral artery aneurysms a true aneurysms mostly located near the skull base. They may present with acute subarachnoid haemorrhage (SAH), but can also be found incidentally on MRI or CT. As many as 20% of patients with subarachnoid haemorrhage have a positive family history. Multiple cerebral artery aneurysms are present in 20%.  In SAH, invasive treatment, either surgical or inventional, is always indicated, because of the high mortality of a second haemorrhage. The work-up must include a selective four-vessel catheter angiography of the carotid and vertebral arteries with compression tests. CT angiography is probably the best non-invasive imaging modality in cerebral aneurysms1.

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Case information

rID: 14472
Case created: 29th Jul 2011
Last edited: 28th Dec 2016
Tags: mca, aneurysm, cta
Inclusion in quiz mode: Included

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