Twig-Like Middle Cerebral Artery: A Rare Cause of Pediatric Stroke That Mimics Moyamoya Disease

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Chhavi Sauparna1, Thanuja Basavanagowda1, Virupaxi Hattiholi2

  • 1Department of Pediatric Neurology, KAHER Deemed to be University's J N Medical College, Belgaum, India.

Journal of Child Neurology
|November 13, 2025
PubMed

Insights

A rare twig-like middle cerebral artery (tMCA) can mimic moyamoya disease. Early recognition is crucial for accurate diagnosis and stroke prevention, especially in infants where it is rarely reported.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Pediatric Neurology

Background:

  • A twig-like middle cerebral artery (tMCA) is a rare vascular anomaly.
  • It can present with serious neurological events like cerebral infarction and hemorrhage.
  • tMCA is often misdiagnosed as moyamoya disease or inflammatory arteriopathy.

Purpose of the Study:

  • To highlight the diagnostic challenges of tMCA.
  • To emphasize the importance of distinguishing tMCA from moyamoya disease for appropriate management.
  • To report the first case of tMCA presenting as stroke in an infant.

Main Methods:

  • Case report of an infant with stroke symptoms.
  • Initial misdiagnosis as moyamoya disease.
  • Review of relevant literature on tMCA.

Main Results:

  • The infant's condition was initially misdiagnosed.
  • The case highlights the rarity and diagnostic difficulty of tMCA in infants.
  • This is the first reported case of tMCA in an infant.

Conclusions:

  • Awareness of tMCA is critical due to its rarity and potential for misdiagnosis.
  • Accurate diagnosis of tMCA is vital for implementing correct monitoring and stroke prevention strategies.
  • This case underscores the need for considering tMCA in pediatric stroke evaluations.
Keywords:
infancymoyamoya diseasestroketwig-like middle cerebral artery

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