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Published on: January 23, 2019
Middle cerebral artery fenestration in patients with cerebral ischemia
Seul-Ki Jeong1, Hyo-Sung Kwak, Young-Il Cho
1Department of Neurology & Research Institute of Clinical Medicine, Chonbuk National University Medical School & Hospital, San 2-20, Geumam-dong, Deokjin-gu, Jeonju, Chonbuk, South Korea (561-180). jeongsk@chonbuk.ac.kr
Background:
We report five cases of middle cerebral artery (MCA) fenestration that might have caused cerebral infarction or ischemia.
Case Report:
Unilateral fenestration of the MCA was observed in five patients with artery-relevant cerebral infarction or ischemia. Enhanced magnetic resonance imaging (MRI) and three-dimensional MR angiography (MRA) were performed in the patients, and a division of the lumen after fenestration was observed using virtual arterial endoscopy. In one patient, MRA and virtual endoscopy showed an obstruction in one limb of the fenestration. The MCA fenestrations were observed in the proximal portion in three cases and the intermediate portion in two cases, and there was no associated aneurysm near or far from the fenestration.
Methods:
The five patients underwent both contrast-enhanced magnetic resonance imaging (MRI) and 3D MRA. Virtual arterial endoscopy was then performed to visualize the division of the lumen, a landmark of fenestration.
Conclusions:
The association between cerebral ischemia and MCA fenestration in the five cases suggests that the fenestration disturbing local flow hemodynamics seems to cause cerebral ischemia, even a direct causative relationship should be elucidated further.
Insights
Middle cerebral artery (MCA) fenestration may cause stroke. This study observed five cases where MCA fenestration potentially led to cerebral infarction or ischemia, suggesting a link to altered blood flow.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Middle cerebral artery (MCA) fenestration is a rare vascular anomaly.
- Its potential role in causing cerebral infarction or ischemia remains under investigation.
Observation:
- Five patients with MCA fenestration and cerebral infarction/ischemia were studied.
- Advanced imaging techniques including MRI, MRA, and virtual endoscopy were utilized.
- Fenestration involved lumen division, with one case showing obstruction.
Findings:
- MCA fenestrations were located in proximal (3 cases) or intermediate (2 cases) portions.
- No associated aneurysms were noted.
- Virtual endoscopy confirmed lumen division and identified obstruction in one case.
Implications:
- MCA fenestration may disrupt cerebral blood flow hemodynamics.
- This disruption is a potential cause of cerebral ischemia and infarction.
- Further research is needed to confirm a direct causal relationship.
