Introduction:
The advent of flow dynamics and the recent availability of perfusion analysis software have provided new diagnostic tools and management possibilities for cerebrovascular patients. To this end, we provide an example of the use of color-coded angiography, and its application in a rare case of a patient with a pure middle cerebral artery malformation.
Methods:
A 42-year-old and chronic smoker male was evaluated at ER due to sudden onset of severe headache, nausea, vomits and left-sided weakness. Head CT revealed a right basal ganglia hemorrhage. Cerebral DSA showed a right middle cerebral artery malformation consisting of convoluted and ectatic collateral vessels supplying the distal middle cerebral artery territory—M1 proximally occluded. An associated medial lenticulostriate artery aneurysm was found. Brain SPECT with and without acetazolamide failed to show problems in vascular reserve that would indicate the need for flow-augmentation.
Results:
Twelve months after discharge, the patient recovered from the left-sided weakness and did not present any similar events. A follow-up DSA and perfusion study using color-coded perfusion analysis showed perforator aneurysm resolution and adequate, albeit delayed perfusion in the involved vascular territory.
Conclusions:
We propose a combined congenital and acquired mechanism involving M1 occlusion with secondary dysplastic changes in collateral supply to distal MCA territory. Angiographic and cerebral perfusion work-up was used to exclude the need for flow-augmentation. Nevertheless, the natural course of this lesion remains unclear and long-term follow-up is warranted.
Patient Care:
Color-coded perfusion studies provide a new diagnostic tool and management possibilities for cerebrovascular patients.
Learning Objectives:
Color-coded perfusion studies provide a new diagnostic tool and management possibilities for cerebrovascular patients.