Accessory middle cerebral artery associated with two intracranial aneurysms

objective and importance: albeit very likely underdisclosed, duplication of the middle cerebral artery (mca) is a rather unfrequently recognized angiographic finding. in this instance the anomaly was associated with two intracranial aneurysms, one ruptured. clinical presentation: an anomalous, twinlike mca, departing from a dominant left precommunicating anterior cerebral artery and extending recurrently toward the sylvian fissure, in close parallelism with the sphenoidal mca segment, was angiographically identified as an accessory mca. the patient was a 74 year old woman being investigated for recent spontaneous subarachnoid hemorrhage. in addition, two intracranial arterial aneurysms were also demonstrated: one originated from the left corner of the anterior communicating artery; the other expanded at the right m1-m2 junction. intervention: the proposed surgical or endovascular treatment was refused but the patient remained hospitalized. sudden neurological deterioration occurred two weeks after hospitalization due to acute hydrocephalus so that an external ventricular drainage system was expeditiously applied. regretfully, the patient did not improve and expired thereof as result of nosocomial pneumonia. necropsy request was not granted. conclusion: we hereby report a new example of accessory mca, in this case associated with two intracranial arterial aneurysms, one ruptured. a brief discussion of the pertinent medical literature is made.