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November 12, 2019; 93 (20) Resident & Fellow Section

Teaching NeuroImages: Rete-like middle cerebral artery

View ORCID ProfileElisa Colombo, View ORCID ProfileWaleed Brinjikji, View ORCID ProfileJames Klaas, View ORCID ProfileGiuseppe Lanzino
First published November 11, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008480
Elisa Colombo
From the Departments of Neurosurgery (E.C.), Radiology (W.B.), and Neurology (J.K., G.L.), Mayo Clinic, Rochester, MN.
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  • ORCID record for Elisa Colombo
Waleed Brinjikji
From the Departments of Neurosurgery (E.C.), Radiology (W.B.), and Neurology (J.K., G.L.), Mayo Clinic, Rochester, MN.
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  • ORCID record for Waleed Brinjikji
James Klaas
From the Departments of Neurosurgery (E.C.), Radiology (W.B.), and Neurology (J.K., G.L.), Mayo Clinic, Rochester, MN.
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Giuseppe Lanzino
From the Departments of Neurosurgery (E.C.), Radiology (W.B.), and Neurology (J.K., G.L.), Mayo Clinic, Rochester, MN.
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Teaching NeuroImages: Rete-like middle cerebral artery
Elisa Colombo, Waleed Brinjikji, James Klaas, Giuseppe Lanzino
Neurology Nov 2019, 93 (20) e1919-e1920; DOI: 10.1212/WNL.0000000000008480

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A 72-year-old woman underwent neuroimaging for evaluation of bilateral vertex headaches. Brain MRI was unremarkable but intracranial magnetic resonance angiography and CT angiography (figure) revealed unilateral, plexiform appearance of the proximal right middle cerebral artery (MCA). The constellation of imaging findings in absence of clinical correlates is consistent with a rete anomaly of the MCA (previously referred to as unfused or twig-like MCA).1 Unilateral involvement, exclusive involvement of proximal MCA, and otherwise normal intracranial vasculature ruled out moyamoya syndrome. The etiopathology of rete MCA anomaly is unknown. Recognition of rete anomaly is important to differentiate it from other vascular diseases and avoid unnecessary treatment.

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Figure CT angiography (CTA) with 3D reconstruction

(A) 3D CTA shows rete-like appearance of the right M1 segment (red circle), normal appearance and caliber of the left M1 (red arrow), bilateral supraclinoid internal carotid arteries (white arrows), and proximal A1 segments (white arrowheads) in a 72-year-old patient, ruling out moyamoya syndrome. (B) Coronal CTA shows plexiform appearance of the right M1 segment (red circle) with distal reestablishment of normal caliber middle cerebral artery typical of rete-like middle cerebral artery.

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No targeted funding reported.

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The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

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  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Teaching slides links.lww.com/WNL/A994

  • © 2019 American Academy of Neurology

Reference

  1. 1.↵
    1. Cho KC,
    2. Kim JJ,
    3. Jang CK,
    4. Hong CK,
    5. Joo JY,
    6. Kim YB
    . Rete middle cerebral artery anomalies: a unifying name, case series, and literature review. J Neurosurg Epub 2018 Aug 3.

Letters: Rapid online correspondence

  • Author response: Teaching NeuroImages: Rete-like middle cerebral artery
    • James Klaas, Neurologist, Mayo Clinic (Rochester, MN)
    • Giuseppe Lanzino, Neurosurgeon, Mayo Clinic (Rochester, MN)
    Submitted December 25, 2019
  • Reader response: Teaching NeuroImages: Rete-like middle cerebral artery
    • Lizhang Chen, Neurologist, West China Hospital, Sichuan University
    • Changwei Zhang, Neurosurgical Doctor, West China Hospital, Sichuan University
    • Hongbo Zheng, Neurologist, West China Hospital, Sichuan University
    Submitted December 03, 2019
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