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Rete middle cerebral artery: a rare association with anterior cerebral artery aneurysm rupture
  1. Bharat Hosur1,
  2. Vikas Bhatia1,
  3. Ajay Kumar1 and
  4. Madhivanan Karthigeyan2
  1. 1Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Vikas Bhatia; drvikasbhatia{at}gmail.com

Abstract

Haemodynamic flow-related stress at the vessel curvatures is an important risk factor for intracranial aneurysmal growth and rupture. The rete middle cerebral artery (MCA) is a rare entity causing hyperdynamic blood flow into the ipsilateral anterior cerebral artery (ACA), especially when the contralateral A1-segment is non-dominant. Ruling out the clinicoradiological mimics like vasculitis, moyamoya and chronic occlusive disease with vessel wall imaging and detailed investigations helps manage the clinical entity effectively. We present a successfully managed case of ruptured ACA aneurysm at the acute curvature of the A1–A2 junction associated with ipsilateral rete MCA. Pre-emptive diagnosis of the rete MCA can aid preventive strategies to manage rupture and regrowth of the aneurysm at the points of flow-related stress.

  • neuroimaging
  • headache (including migraines)

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Footnotes

  • Contributors BH contributed in imaging and treatment workflow protocols, postprocessing and manuscript preparation. VB and AK reviewed imaging, performed coiling and conceptualised the manuscript. MK was instrumental in clinical management and provided intellectual contribution.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.