- Case report
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Duplicated middle cerebral artery associated with aneurysm at M1/M2 bifurcation: a case report
© The Author(s). 2018
- Received: 12 November 2017
- Accepted: 28 August 2018
- Published: 1 October 2018
A duplicated middle cerebral artery arises from the internal carotid artery and supplies blood to the middle cerebral artery territory. A duplicated middle cerebral artery is sometimes associated with an intracranial aneurysm. Most aneurysms associated with duplicated middle cerebral artery are located at the origin of the duplicated middle cerebral artery. An aneurysm located at the distal middle cerebral artery is not common.
We encountered a 62-year-old Asian man with duplicated middle cerebral artery associated with aneurysms at the M1/M2 junction of the duplicated middle cerebral artery and top of the internal carotid artery.
In cases of duplicated middle cerebral artery, association with a distal aneurysm on the duplicated middle cerebral artery is rare. However, the aneurysm may be formed on the thicker middle cerebral artery due to hemodynamic stress.
- Duplicated middle cerebral artery
Some anomalies of the middle cerebral artery (MCA) have been reported on autopsy and radiological examinations . Among them, a duplicated MCA (DMCA), accessory MCA, and fenestration are well known [1–3]. DMCA arises from the internal carotid artery (ICA) and supplies blood to the MCA territory. The incidence of DMCA has been reported to be 0.7–2.9% on autopsy and 0.24–1.5% on angiography .
There have been some reports describing cases of an anomalous MCA associated with an aneurysm [3, 5, 6]. Approximately 35 cases of DMCA associated with aneurysms have been reported in the literature [6–11]. Most of the cases had an aneurysm at the origin of the DMCA, and an aneurysm located at the distal DMCA was not common. To the best of our knowledge, only five cases of DMCA associated with distal MCA aneurysms have been reported [12–15]. Although the incidence is low, we should be aware of the association of DMCA and aneurysm.
We encountered a patient with DMCA and an aneurysm at the M1/M2 junction of the DMCA. This patient also had a small aneurysm at the top of the ipsilateral ICA. In this case report, we describe the patient with DMCA, and aneurysms on the distal DMCA and top of the ICA, and discuss the radiological findings and characteristics of the rare vascular anomaly and associated aneurysms.
Summary of cases of duplicated middle cerebral artery accompanied with distal aneurysms
Age (years), sex
Size of MCA (mm)
Location of aneurysm
Size of aneurysm (mm)
Associated aneurysm or vessel anomaly
M1 of main MCA
M1/M2 of main MCA
Both arteries were similar in size
Sylvian portion of the main MCA
Contralateral MCA aneurysm (superior trunk)
Both arteries were similar in size
Distal trunk of DMCA
Bilateral accessory MCA
DMCA was smaller than the main MCA
Inferior division of main MCA
ND (> 10 mm in figure)
Almost the same
Ipsilateral ICA top aneurysm
In cases of DMCA, association with a distal aneurysm on DMCA is rare. However, the aneurysm may be formed on the thicker MCA due to hemodynamic stress.
This research was partly supported by research funds to promote the hospital functions of Japan Organization of Occupational Health and Safety.
Availability of data and materials
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
KM drafting of manuscript, critical revision, treatment of patient. AT drafting of manuscript, critical revision, treatment of patient. SS drafting of manuscript, critical revision, treatment of patient. YI drafting of manuscript, critical revision, treatment of patient. YK drafting of manuscript, critical revision, treatment of patient. TN drafting of manuscript, critical revision, treatment of patient. MN study conception and design, drafting of manuscript, critical revision, treatment of patient. All authors read and approved the final manuscript.
Ethics approval and consent to participate
Ethical approval was obtained from the Human Research Ethics Committee of Yokohama Sakae Kyosai Hospital.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
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