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Accessory Middle Cerebral Artery Originating from the Posterior Circulation, Presenting with an Occult Ruptured Cerebral Aneurysm: a Case Report—Management of Atypical Subarachnoid Haemorrhage Cases with Rare Vascular Variations

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Abstract

An accessory middle cerebral artery (aMCA) is a rare anatomical variation which has been linked to cerebrovascular aneurysms. There has never been an aMCA with a posterior circulation origin reported in the literature. We present a case report of a posterior circulation aMCA and a concomitant ruptured native MCA bifurcation aneurysm. Initial workup was non-diagnostic but clinical suspicion, and the existence of this rare variation orientated our management towards an exploratory craniotomy. A blister aneurysm was recognized on the native M1 bifurcation and was clipped with a single clip. Patients with rare vascular variations should be aggressively investigated for cerebrovascular aneurysms. Especially when there is clinical suspicion, further workup or even exploration is warranted.

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Data presented in this article are accurate and available. Important data are all included in this publication.

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Abbreviations

MCA:

Middle cerebral artery

P1:

Pre-communicating segment of the posterior cerebellar artery

CT:

Computed tomography

CTA:

Computed tomography angiography of the cerebral arteries

DSA:

Digital subtraction angiography

SAH:

Subarachnoid haemorrhage

aMCA:

Accessory middle cerebral artery

M1:

First division of the middle cerebral artery

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Authors and Affiliations

  1. Department of Neurosurgery, GHA G. Gennimatas, Diadochou Konstaninou 102, Paiania, 19002, Athens, Attica, Greece

    Alexandros Blionas, Savvas Melissaris, Christos Zlatanos & Nikolaos Georgakoulias

Authors
  1. Alexandros Blionas
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  2. Savvas Melissaris
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  3. Christos Zlatanos
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  4. Nikolaos Georgakoulias
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Contributions

All authors have contributed sufficiently towards the presented case management and the writing and preparation of this publication.

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Correspondence to Alexandros Blionas.

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Blionas, A., Melissaris, S., Zlatanos, C. et al. Accessory Middle Cerebral Artery Originating from the Posterior Circulation, Presenting with an Occult Ruptured Cerebral Aneurysm: a Case Report—Management of Atypical Subarachnoid Haemorrhage Cases with Rare Vascular Variations. SN Compr. Clin. Med. 4, 33 (2022). https://doi.org/10.1007/s42399-021-01086-w

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