Dissecting aneurysm of cerebral arteries in childhood and adolescence

Summary A nine year old girl died with a massive infarct of the right cerebral hemisphere causing transtentorial and foramen magnum herniation. The infarction was secondary to an idiopathic dissecting aneurysm. The case is unusual in that the supraclinoid segment of the right internal carotid artery, the anterior cerebral artery, and the middle cerebral artery and its three branches were embedded and sectioned longitudinally. The dissection commenced in the supraclinoid segment of the right internal carotid artery, extended into the middle and anterior cerebral arteries, and was accompanied by thrombosis of the false lumen. A literature review of 20 pediatric cases indicates the malignant natural course of the disease (76% mortality in the first two months), and emphasizes the characteristic angiographic string sign. The diagnosis of cerebral arterial dissection during life depends on angiography and a high index of suspicion.     

应用MRA研究大脑前动脉A1段发育与交通动脉开放之间的关系

目的　探讨大脑前动脉A1段发育与前后交通动脉开放情况之间的关系。方法 回顾性分析了107例3.0T磁共振血管成像（MRA）无脑血管病的检查者和体检者。观察双侧大脑前动脉A1段发育、前交通动脉和双侧后交通动脉开放情况,测量双侧大脑前动脉A1段、前交通动脉及后交通动脉的管径,分析二者的相关性。  结果　①右侧大脑前动脉A1段发育不良占22.43%（24/107）,缺如占0.93%（1/107）,左侧大脑前动脉A1段发育不良占16.82%（18/107）,缺如占1.87%（2/107）。②前交通动脉开放占47.66%（51/107）。③单侧或双侧后交通动脉开放共有39例,其中双侧同时开放占21例,仅左侧开放占7例,仅右侧开放占11例。④大脑前动脉A1段发育不良与交通动脉开放相关（r=0.654,P＜0.01）。  结论 大脑前动脉A1段发育不良可引起交通动脉代偿性开放。     

Wingspan Stenting for Symptomatic Severe In-Stent Stenosis of a Closed-Cell Stent after Stent-Assisted Coiling of a Ruptured Intracranial Aneurysm

We report the 3-year follow-up result of Wingspan intracranial stenting for symptomatic severe in-stent stenosis after stent-assisted coiling (SAC) for a ruptured left distal internal carotid artery (ICA) aneurysm. A middle-aged male patient visited our hospital for in-stent stenosis of a stent that was placed to treat a ruptured ICA aneurysm. Routine follow-up cerebral angiography, 1 year after SAC, showed in-stent stenosis around the distal markers of the inserted stent at the left M1 proximal segment. Six months later, he developed right dysesthesia. We performed intracranial stenting with Wingspan stent for the in-stent stenosis. Follow-up digital subtraction angiography performed 1 year after the Wingspan stenting showed good patency of the ICA and middle cerebral artery flow without evidence of restenosis. At 3-year follow-up, magnetic resonance angiography showed sufficient middle cerebral artery flow although the stenting segment could not be visualized clearly. Wingspan stenting might be a feasible option in patients with iatrogenic intracranial stenosis resulting from in-stent stenosis who experience the progression of intracranial stenosis with manifestation of neurological symptoms despite dual anti-platelet therapy.     

A fusiform aneurysm of a persistent trigeminal artery variant: case report and literature review

A 48-year-old man suffered from spontaneous subarachnoid hemorrhage. Emergent right internal carotid angiography showed the presence of a persistent trigeminal artery (PTA) variant with a fusiform aneurysm on its proximal segment where it branched from the internal carotid artery. This artery supplied the territory of the anterior inferior cerebellar artery. After consideration of the adequacy of the cerebellar circulation without this anomalous artery, intraluminal occlusion of the aneurysm together with the PTA variant was performed using detachable coils. The patient recovered uneventfully without any neurologic deficits.     

Anatomical variant of origin of ophthalmic artery: case report

We report on one case of variant origin of right ophthalmic artery (OA) from C4 choroidal segment of the right supraclinoid internal carotid artery. A 41-year-old woman affected by bitemporal hemianopsia performed Magnetic Resonance Imaging with gadolinium showing tuberculum sellae meningioma. During angiography we observed this variant of origin of OA. At surgical dissection, we observed this variant in carotid cistern.     

颈动脉分叉部的三维CT血管成像解剖测量

背景：解剖测量是临床医学的基础,可为临床影像学诊断与外科手术提供依据与参考。利用三维CT血管成像技术进行相关解剖测量具有明显的技术优势与很好的应用前景。 目的：应用64排螺旋CT血管成像对颈动脉分叉部的形态结构进行测量,为相关研究提供解剖基础。 方法：查阅2008年6月至2010年6月于厦门大学附属中山医院影像科行头颈部64排螺旋CT血管成像受检者的扫描图像,随机选取颈动脉分叉部无明显病变者92例。其中男45例,女47例;≤40岁者40例,> 40岁者52例。利用其断面图像进行三维成像处理,获得满意的三维图像后,对颈动脉分叉部相关结构进行解剖学测量。 结果与结论：三维图像可清晰显示颈动脉分叉部结构,实现其结构的单独和多结构、多方向观察及测量。测量结果显示受试者颈动脉分叉角为(43.5±12.3)°,颈总动脉远端内径(6.83±0.65) mm,颈内动脉膨大区近端内径(7.25±1.04) mm,颈内动脉膨大区最大内径(8.15±1.35) mm,颈内动脉膨大区远端内径(5.03± 0.55) mm,颈外动脉内径(4.22±0.60) mm。与≤40岁组比较,>40岁组颈动脉分叉角度、颈内动脉膨大区近端内径、颈内动脉膨大区最大内径、颈内动脉膨大区远端内径均明显粗大,颈外动脉内径明显细小(P < 0.05),而颈总动脉内径差异无显著性意义(P > 0.05)。与男性组比较,女性组颈动脉分叉部各测量指标均显著细小(P < 0.05)。左、右侧组测量值比较,除颈动脉分叉角左侧明显大于右侧外,其他测量指标差异均无显著性意义(P > 0.05)。三维CT可客观、准确测量颈动脉分叉部相关解剖值,具有个体化特征,可为相关应用解剖、疾病诊断及介入或手术治疗提供客观依据。     

Duplicate origin of the anterior cerebral artery diagnosed by magnetic resonance angiography: a case report

An anterior cerebral artery (ACA) of duplicate origin results from the fusion of two arteries that arise from the terminal segment of the internal carotid artery (ICA) to form a ring. This variation is extremely rare and differs from proximal ACA fenestration, supraclinoid fenestration of the ICA, and duplicate origin of the middle cerebral artery. We report a case diagnosed incidentally by magnetic resonance angiography.     

Infraoptic anterior cerebral artery: case series report and literature review

An infraoptic course of the precommunicating anterior cerebral artery (A1 segment) is a rare anomaly. We report three patients with an infraoptic A1 diagnosed by computed tomography angiography and we review the literature focusing on embryological development. In all three patients, a left infraoptic A1 that originated from the ophthalmic level of the internal carotid artery was diagnosed incidentally. Only one patient had a normal supraoptic A1. The embryogenesis of this anomaly is unclear. We propose that an error in the development of the definitive ophthalmic artery is possible mechanisms giving rise to this anomaly.     

头臂干缺如及其分支变异1例并文献复习

目的:报道头颈部血管起源变异,探讨其临床意义.方法:对相关病例作全脑血管造影检查,显示起源变异血管的分布情况.结果:头臂干缺如,右侧颈总动脉、右侧锁骨下动脉直接起源于主动脉弓,右侧椎动脉起源于右侧颈总动脉.结论:右侧椎动脉起源位置变异可能与诱发短暂脑缺血发作有关.     

Spontaneous recanalization of a pseudoocclusion of the internal carotid artery in a 70-year-old woman

Summary A 70-year-old woman suffered paresis of the left hand with dysaesthesia of the head lasting about 12 hours. The Doppler-flow study and duplex scan of the carotid arteries performed 14 days later showed an occluded right internal carotid artery. She refused angiography. However, 7 days later she was willing to undergo further investigation. This time the Doppler flow study and duplex scan demonstrated regular flow without stenosis, which suggested spontaneous recanalization of the formerly occluded right internal carotid artery.Abbreviations ACC common carotid artery - ACI internal carotid artery - ACE external carotid artery     

大脑前动脉A1段的显微解剖与数字减影血管造影对照观测及临床意义

目的 为临床选择颅内血管支架的类型和放置部位提供解剖学基础。方法 选取尸头标本20具,经双侧翼点入路显微解剖观测大脑前动脉A1段及其穿支血管。选取无病变的全脑DSA 100例,观测大脑前动脉A1段的走行及其穿支的开口部位。结果 显微解剖大脑前动脉A1段的长度和直径分别为（13.55±1.43） mm、（2.43±0.37） mm,DSA血管造影的长度和直径分别为（13.42±1.57） mm、（2.28±0.40） mm,显微解剖与DSA血管造影直径的差异有统计学意义（P〈0.05）。大脑前动脉A1段的穿支发自其后上壁,近侧段穿支数目（2.55±0.39）支,中间段（0.52±0.46）支,远侧段（1.12±0.11）支,近侧、中间、远侧段的穿支数目的差异均有统计学意义（P值均〈0.05）。男性较女性的大脑前动脉A1段长、直径粗,两者差异均有统计学意义（P值均〈0.05）。结论 大脑前动脉A1段的显微解剖与数字减影血管造影对照观测对临床选择颅内血管支架的类型和放置部位,避免血管支架阻塞穿支开口处,防止术后穿支供应区域缺血等具有重要的临床意义。     

Unilateral agenesis of the internal carotid artery presented as transient ischaemic attack: a case report

Dysgenesis of the internal carotid artery (ICA) is a rare vascular disorder with a variety of different grades (agenesis, aplasia, and hypoplasia). The left internal carotid artery is reported to be affected by dysgenesis three times more often than the right one. Most of the patients with dysgenesis of the internal carotid artery are asymptomatic. We report a case of a patient with right internal carotid artery agenesis presented to our hospital as transient ischaemic attack. CT scans at skull base level with bone settings showed absence of the right carotid canal, consistent with congenital agenesis of the internal carotid artery. MR imaging of the brain revealed signal void of the intracranial portion of right internal carotid artery. Maximum intensity projection reconstruction confirmed the agenesis of the right ICA, with the right middle cerebral artery fed through a dilated posterior communicating artery and the right anterior cerebral artery supplied by the anterior communicating artery (fetal type of collateral flow). In patients with agenesis of the internal carotid artery non-invasive imaging techniques are currently the mainstay of diagnosis.     

新西兰大白兔脑动脉系统的数字减影血管造影成像

目的研究新西兰大白兔脑动脉系统的特点,为建立兔脑血管疾病模型奠定基础。方法新西兰大白兔20只,采用数字减影血管造影(DSA)方法,通过新西兰大白兔股动脉将微导管导入颈内动脉近端造影,分析新西兰大白兔脑动脉系统解剖。结果颅内前后循环系统显影清楚;新西兰大白兔具有与人类相似的脑动脉系统。结论超选择性脑血管造影有利于更好地显示兔脑前后动脉系统,新西兰大白兔脑动脉系统与人类相似,为建立兔脑动脉系统血管疾病模型提供较详细的影像学基础。     

320排螺旋CT三维重建大脑前动脉的临床影像解剖学研究

目的　观测大脑前动脉的起源、走行及分支分布规律，期为脑血管疾病的诊疗提供影像学依据。 方法　随机收集100例无血管疾病的脑部多层螺旋CTA影像资料，利用其自带工作站进行图像后处理，观察大脑前动脉的影像解剖学结构。 结果　（1）测得大脑前动脉各段的数值，大脑前动脉A1段长度、内径及A1-A2夹角左右侧有统计学差异；（2）大脑前动脉走形变异率20%（20/100），其中左侧A1段优势征9%，右侧A1段优势征5%，左侧A1段缺如1%，双侧大脑前动脉发育不良1%，左侧A4、A5段代偿供血1%，右侧A1段优势征合并同侧A2~A5段狭窄（由左侧A2~A5段代偿供血）1%，A4、A5共干1%，双侧A1段畸形1%；（3）大脑前动脉单干型71%，双干型29%。 结论　多层螺旋CTA能清晰立体地显示大脑前动脉的全长和主要分支及其解剖变异；大脑前动脉的变异复杂，左右差异显著，可为临床病变的早期诊断和治疗提供可靠依据。     

Aberrant petrous internal carotid artery with cochlear anomaly-an unusual association

The magnetic resonance imaging (MRI) in a female patient who presented with headache and hearing loss revealed aberrant course of the petrous segment of internal carotid artery (ICA). Computed tomography (CT) of the temporal bone done to confirm the findings of MRI revealed aberrant course of right ICA, a persistent stapedial artery (PSA) and absent foramen spinosum on the same side. In addition patient had a cystic cochleovestibular anomaly on the right side with both conditions may probably be contributing to her hearing loss.     

Type 2 proatlantal intersegmental artery associated with persistent trigeminal artery diagnosed by MR angiography

Purpose

The type 2 proatlantal intersegmental artery (PIA) is a rare anastomosis between the external carotid artery (ECA) and vertebral artery (VA) that passes through the foramen magnum. The persistent trigeminal artery (TA) is the most common anastomosis between the internal carotid artery (ICA) and basilar artery. The purpose of this paper is to present the first case of a type 2 PIA associated with an ipsilateral persistent TA diagnosed using magnetic resonance (MR) angiography, and we briefly discuss the embryology of this rare anomaly.

Methods

An 83-year-old man with cerebral infarctions underwent cerebral MR imaging, and head and neck MR angiography using a 1.5?T imager. MR angiography was obtained using the standard non-contrast three-dimensional time-of-flight technique.

Results

MR angiography showed aplasia of the proximal left VA and a large anastomotic artery between the left ECA and distal left VA that passed through the foramen magnum, indicative of a type 2 PIA. This patient also had an anastomosis between the precavernous segment of the left ICA and midbasilar artery via a lateral course, indicative of a lateral-type persistent TA.

Conclusion

We present the first case of type 2 PIA associated with ipsilateral lateral-type persistent TA diagnosed by MR angiography. MR angiography should be performed including the carotid bifurcation to find more frequently extracranial arterial variations, including type 2 PIAs.     

Complex anomalies of type 1 proatlantal intersegmental artery and aortic arch variations

Purpose

We report a case of type 1 proatlantal intersegmental artery (PIA) associated with multiple anomalies of the aortic arch, and discuss the possible embryonic mechanism and clinical importance of the multiple cerebrovascular variants in this patient.

Methods

A 65-year-old woman with dizziness underwent cerebral magnetic resonance (MR) imaging and head and neck MR angiography using a 3-tesla scanner and computed tomography (CT) angiography using a 64-slice multidetector CT scanner.

Results

MR and CT angiography demonstrated an aneurysm of the distal end of the azygos anterior cerebral arteries and hypoplasia of the proximal right vertebral artery (VA) with an anastomotic artery, between the right internal carotid artery (ICA) and distal right VA that passed through the foramen magnum, indicating a type 1 PIA. She also demonstrated an aberrant right subclavian artery (ARSA) with hypoplasia of the right VA, and the left VA arose directly from the aortic arch.

Conclusion

To our knowledge, this is the first report of a type 1 PIA associated with multiple vascular anomalies of the aortic arch, such as ARSA and origin of the left VA from the arch. In cases of persistent anastomoses between the carotid and vertebrobasilar arteries, such as PIAs, imaging examination should include the aortic arch to identify associated vascular variations.     

Systematization,Description, and Territory of the Middle Cerebral,Rostral, and Cerebroethmoidal Arteries on the Surface of the Brain of the Ostrich (Struthio camelus)

Thirty ostrich specimens were injected with red-dyed latex via the internal carotid arteries (Aa.) The middle cerebral and cerebroethmoidal arteries and their branches were systematized. The middle cerebral artery (a.) was always a single large vessel. On the right side, it had two, three, or one developed medial hemispheric branches in 46.6%, 26.7%, and 26.7% of cases, respectively. On the left side, one (36.7%), two (33.3%), and three (30%) developed medial hemispheric branches were observed. The middle cerebral artery had eight (40%), nine (20%), seven (16.7%), eleven (6.7%) ten (6.7%), twelve (3.3%), six (3.3%), and five (3.3%) developed lateral hemispheric branches on the right side and seven (46.7%), nine (13.3%), eight (13.3%), six (10%), five (10%), and ten (6.7%) on the left. Two (33.3%), four (20%), three (20%), one (16.7%), and five (10%) direct perforating branches of the middle cerebral artery were present on the right, and three (33.3%), two (30%), one (13.4%), six (10%), four (10%), and five (3.3%) were present on the left. The cerebroethmoidal artery, always present as a natural continuation of the rostral terminal branch of the brain's carotid artery and originating from the middle cerebral artery, was a large vessel that projected rostromedially, giving off the rostral cerebral artery shortly after its formation and continuing as the ethmoidal artery. The rostral cerebral artery was a single (90%) and double (10%) vessel on the right and a single (96.7%) and double vessel (3.3%) on the left. The ethmoidal artery was always a medium to large single vessel and was the natural continuation of the cerebroethmoidal artery, immediately after giving off the rostral cerebral artery. Anat Rec, 302:1187–1194, 2019. © 2018 Wiley Periodicals, Inc.