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

Teaching NeuroImages: Rete-like middle cerebral artery

Elisa Colombo, Waleed Brinjikji, James Klaas, Giuseppe Lanzino
First published November 11, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008480
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Article Figures & Data

Figures

  • Figure
    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.

Tables

  • Table1
  1. Elisa Colombo, MD,
  2. Waleed Brinjikji, MD,
  3. James Klaas, MD and
  4. Giuseppe Lanzino, MD
  1. From the Departments of Neurosurgery (E.C.), Radiology (W.B.), and Neurology (J.K., G.L.), Mayo Clinic, Rochester, MN.
  1. Correspondence
    Dr. Lanzino Lanzino.giuseppe{at}mayo.edu
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  1. NONE

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  1. NONE

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  1. NONE

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  1. NONE

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  1. NONE

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  1. NONE

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  1. 1. Journal of Neuroradiology, Associate Editor, 1 year 2. Cerebrovascular Diseases, Editorial Board, 1 year 3. Stroke, Social Media Editor, 3 months.

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  1. Superior Medical Editing (Commercial for profit)

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  1. Journal of Neurosurgery, Editorial Board Member 2007-2013 Neurocritical Care, editorial Board Member 2009 Stroke, Section editor for Neurosurgery 2009-present

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  1. Cavernous Malformations of the Brain and Spinal Cord (Thieme,2008)

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  1. Superior Medical Editing Stock/Stock Options, Medical Equipment & Materials: Marblehead OneOme

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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.

Figure
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.

Study funding

No targeted funding reported.

Disclosure

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

Appendix Authors

Table

Footnotes

  • 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

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.

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