AUTHOR=Xiao Wen , Hou Xiaolin , Li Dingjun , Yang Dongdong 

TITLE=False positive angiographic aneurysm of the anterior segment of the M1 bifurcation of the middle cerebral artery: a case report

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1327878

DOI=10.3389/fneur.2023.1327878

ISSN=1664-2295

ABSTRACT=Occlusion of an intracranial arterial branch, resulting in a false positive aneurysm on vascular imaging, is extremely rare, with only a few reports, mostly in the posterior circulation artery or the middle cerebral artery (MCA) bifurcation. A 69-year-old woman with a subacute infarct lesion in the left frontal lobe, and both CTA and DSA of the cerebral vessels showed aneurysms in the anterior segment of the M1 bifurcation of the middle cerebral artery (MCA) and in the bifurcation of the MCA. The aneurysm in the MCA bifurcation was found during craniotomy, whereas the anterior segment of the M1 bifurcation had intact branch vessels with severe atherosclerosis and no aneurysm was present. The branch vessel of M1 is presumed to be atherosclerotic occlusion resulting in the distal vessels without contrast filling on CTA and DSA, and only the occluded stump at the beginning of the vessel is filled with contrast, showing an aneurysm-like morphology, which is very confusing. This case reminds neurologists that the diagnosis of aneurysm by cerebrovascular CTA or DSA must be carefully differentiated to avoid misdiagnosis, especially if the unruptured aneurysm in an uncommon location in combination with ischemic cerebrovascular disease.