Introduction. Less than half of all subjects display a normal configuration of the Circle of Willis, according to anatomical studies. Variations of the middle cerebral artery (MCA) such as duplication or accessory MCA are infrequent but nevertheless have important clinical implications. We report the case of two patients with these variations of the MCA and their repercussions in the management of acute stroke are discussed. Case reports. Case 1: a 53-year-old male with a 2-hour history of sensory-motor syndrome; a transcranial Doppler (TCD) scan revealed asymmetrical speeds in the MCA. Spontaneous perforation of the MCA was suspected and we therefore decided to perform a magnetic resonance angiography scan before administering fibrinolytics. The magnetic resonance angiography scan showed an accessory MCA lying ipsilateral to the lesion. We interpreted the anomalies in blood flow detected in the TCD recording as being secondary to this anatomical variation and not due to reperfusion. Following the magnetic resonance angiography study, the possibility of fibrinolysis was ruled out. The patient recovered the neurological deficit in a matter of hours. Case 2: a 21-year-old female with headaches and transient hemiparesis, who was diagnosed as suffering from migraine with aura. Later, following another stroke, it was shown that the previous clinical symptoms had been secondary to intracranial dissection with embolism in the lenticulostriate arteries and ischemic infarction in that territory. A magnetic resonance angiography scan showed duplication of the ipsilateral MCA. Conclusions. The double vascularisation of the hemisphere in cases of anatomical duplication can give rise to strokes with a better progression and prognosis, despite the occlusion of one of the MCA. The presence of anatomical variations of the MCA can lead to mistaken interpretations of the transcranial Doppler scan and may affect decision-making as regards the therapy to be employed in patients with acute stroke.
KeywordsAccessory arteryAnatomical variationsDuplicationMiddle cerebral arteryStrokeTranscranial DopplerCategoriesPatología vascular
FULL TEXT(solo disponible en lengua castellana / Only available in Spanish)
Si ya es un usuario registrado en Neurologia, introduzca sus datos de inicio de sesión.
Rellene los campos para registrarse en Neurologia.com y acceder a todos nuestros artículos de forma gratuita
¿Olvidó su contraseña? Introduzca su correo electrónico y le haremos llegar una nueva
¡CONVIÉRTASE EN USUARIO PREMIUM DE NEUROLOGIA.COM!
Al hacerse premium, está apoyándonos para que Revista de Neurología
siga siendo uno de los referentes de habla hispana en la difusión del
conocimiento en neurociencias. ¡Gratuita tanto para autores como para
todos los usuarios de la web!
Además, por convertirte en usuario premium, recibirá las siguientes ventajas:
Plaza asegurada en todos nuestros Másteres (www.ineurocampus.com)
Descuento del 5% en los cursos de “Actualización en Neurología”, la FMC que estará disponible próximamente en la web.
Descarga gratuita en formato PDF dos de las obras con más éxito publicadas por Viguera Editores:
Oromotors Disorders in childhood (M. Roig-Quilis; L. Pennington)
Manual de Neuropsicología 2ª ed. (J. Tirapu-Ustárroz; M. Ríos-Lago; F. Maestú)
El precio para hacerse Premium durante el periodo de un año es de 5€, que podrá pagar a continuación a través de una pasarela de pago seguro con tarjeta de crédito, transferencia bancaria o PayPal:
OPEN ACCESS
