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Updated: Jun 2, 2026
Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
Middle cerebral artery duplication : classification and clinical implications
Hoe Young Chang1, Myoung Soo Kim
1Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Insights
The study identified two types of duplicated middle cerebral arteries (DMCAs), suggesting they arise from different embryological origins. Type A DMCAs likely represent early MCA bifurcations, while Type B DMCAs may stem from direct MCA trunk or temporal branch origins.
Area of Science:
- Neuroanatomy
- Vascular Neurology
- Embryology
Background:
- The embryological origin of duplicated middle cerebral arteries (DMCAs) remains unclear despite various proposed explanations.
- Understanding DMCA origins is crucial for interpreting neuroimaging findings and potential clinical implications.
Purpose of the Study:
- To review anomalous duplicated middle cerebral arteries (DMCAs) and propose a theory for their diverse origins, sizes, and courses.
- To differentiate between types of DMCAs based on their anatomical characteristics.
Main Methods:
- Retrospective review of 1,250 cerebral angiographies, 1,452 CT-angiographies, and 2,527 MR-angiographies.
- Identification and classification of duplicated middle cerebral arteries (DMCAs) based on origin and morphology.
Main Results:
- Twenty-five cases of duplicated middle cerebral arteries (DMCAs) were identified.
- Type A DMCAs (n=8) originated near the internal carotid artery terminal, with similar diameters and parallel courses to the other MCA branch.
- Type B DMCAs (n=17) originated between the anterior choroidal artery and internal carotid artery terminus, showing varied diameters and courses (parallel or temporal lobe-curving).
Conclusions:
- Type A DMCAs are likely early bifurcations of the middle cerebral artery (MCA).
- Type B DMCAs are proposed to be direct bifurcations of the MCA trunk or early ramifications of the MCA's temporal branch.
Objective:
Although there are several explanations for a duplicated middle cerebral artery (DMCA), its embryological origin is still an open question. We reviewed these anomalous vessels to postulate a theory of their different origins, sizes, and courses.
Methods:
A retrospective review of 1,250 cerebral angiographies, 1,452 computed tomography (CT)-angiographies, and 2,527 magnetic resonance (MR)-angiographies was performed to identify patients with DMCA.
Results:
Twenty-five patients had 25 DMCAs. Conventional angiography detected nine patients with DMCA (9/1250, 0.72%), MR-angiography detected seven patients with DMCA (7/2527, 0.28%), and CT-angiography detected nine patients with DMCA (9/1452, 0.62%). The DMCAs originated near the internal carotid artery terminal in eight patients (type A), and between the origin of the anterior choroidal artery and the terminal internal carotid artery in 17 patients (type B). The diameters of the eight type A DMCAs were the same or slightly smaller than those of the other branch of the DMCA. All type A DMCAs showed a course parallel to that of the other branch of the DMCA. The diameters of the 17 type B DMCAs were the same, slightly smaller, or very much smaller than that of the other branch of the DMCA. Nine type B DMCAs showed parallel courses, and the other eight curved toward the temporal lobe.
Conclusion:
The two branches of the type A DMCAs can be regarded as early bifurcations of the MCA. The branches of the type B DMCAs had parallel courses or a course that curved toward the temporal lobe. The type B DMCA can be regarded as direct bifurcations of the MCA trunk or the early ramification of the temporal branch of the MCA.
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