Presentation
Anamnesis of an ischemic stroke several years ago. Suspected new stroke.
Patient Data
NECT of the brain shows a zone of post-ischemic encephalomalacia in the left striatocapsular region with widening of the left lateral ventricle. No signs of intracranial bleeding or new ischemic changes.
A small hyperdense subcortical lesion in the right frontal lobe with no perifocal edema, probably consistent with a vascular lesion.
Polypoid changes of the paranasal sinuses.
CTA demonstrates an absence of the main trunk of the right MCA with multiple small vessels reconstituting it.
Severe stenosis of the M1 segment of the left MCA.
Fetal origin of right PCA - an absence of P1 segment with a good developed PCom which continues into P2 segment of PCA.
Developmental venous anomaly (DVA) in the right frontal lobe which drains into the right internal cerebral vein.
Case Discussion
This case demonstrates the absence of the main trunk of the right middle cerebral artery (MCA). It is not a result of arterial occlusive disease, as there are no ischemic or post-ischemic changes in the right MCA territory, which would inevitably occur in the case of occlusion of such a significant cerebral artery. Instead, it is a developmental anomaly known as a twig-like MCA.
Additionally, there is an incidental variant anatomy of the right posterior cerebral artery (PCA) with a fetal origin, along with a developmental venous anomaly (DVA) of the right frontal lobe.