Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
OtherBRAIN

A Rare Anatomic Variant of a Solitary Internal Carotid Artery Associated with Moyamoya Phenomenon of the Middle Cerebral Artery

G.K.C. Wong, S.C.H. Yu, G.E. Antonio and W.S. Poon
American Journal of Neuroradiology October 2006, 27 (9) 2012-2013;
G.K.C. Wong
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
S.C.H. Yu
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
G.E. Antonio
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
W.S. Poon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
Loading

Abstract

SUMMARY: A case of a congenital solitary internal carotid artery with complicated anastomosis is presented. This rare anomaly was an incidental finding at cerebral angiography in a patient with a poor-grade subarachnoid hemorrhage and a ruptured anterior communicating artery aneurysm.

We describe a case of a congenital solitary internal carotid artery arising from the right side in a patient with a poor-grade subarachnoid hemorrhage and a ruptured anterior communicating artery aneurysm. There was also complete occlusion of the proximal right middle cerebral artery with collaterals reconstituting the terminal branches of the right middle cerebral artery. Such findings are extremely rare.

Case Report

An 81-year-old woman presented with sudden collapse. On admission to our institution, the patient was unconscious. The Glasgow Coma Scale score on examination was 9/15. Blood pressure and pulse were stable. Noncontrast cranial CT findings were diffuse subarachnoid hemorrhage (SAH) and moderate hydrocephalus. An emergency operation with an external ventricular drain was inserted to treat the hydrocephalus.

Because of the finding of diffuse SAH in a patient without a history of head injury, CT angiography and subsequent conventional angiography were performed because a ruptured cerebral aneurysm was suspected. The angiograms showed that the solitary internal carotid artery arose from the right side (Figs 1 and 2), and the left internal carotid artery was absent from the left common carotid injection. The right internal carotid artery turned leftward after its exit from the cavernous sinus. The solitary internal carotid artery supplied both anterior cerebral arteries. There was a small aneurysm at the anterior communicating artery, measuring 2.6 × 1.6 mm, with a daughter sac at its fundus, forming an L-shaped configuration. The proximal right middle cerebral artery was completely occluded with collaterals reconstituting the terminal branches of the right middle cerebral artery. The left middle cerebral artery was supplied by the vertebrobasilar system through a large left posterior communicating artery. Venous structures were unremarkable. The absence of the left carotid canal was shown on bone window settings.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Frontal view of right internal carotid injection shows the solitary right internal carotid artery, Moyamoya phenomenon of the right middle cerebral artery, and anterior communicating artery aneurysm.

Fig 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 2.

Lateral view of right internal carotid injection shows the right ophthalmic artery and an infundibulum at its origin.

The aneurysm was very small and wide-necked and thus was not suitable for embolization. The patient’s condition continued to deteriorate, and she died 15 days after admission, with pneumonia.

Discussion

Agenesis of the internal carotid artery is rare.1 “Agenesis” refers to the total absence of the entire artery due to an embryologic arterial developmental failure. “Aplasia” denotes that vestiges are present, and “hypoplasia,” that the vessel is present but small. The key to differentiation is to use the CT bone window setting to assess the presence of the bony carotid canal, which is absent in the case of agenesis. Agenesis of the internal carotid artery is associated with vascular anomalies such as cerebral aneurysms and abnormal collateral channels. There were 6 reported cases in the literature associated with anterior communicating artery aneurysm,2–5 as in our case. The aneurysm formation was thought to be flow-related in these cases. In our patient, the solitary internal carotid artery supplying both anterior cerebral arteries was an example.

This patient’s contralateral middle cerebral artery was supplied by the vertebrobasilar system through a fetal-type posterior communicating artery. The other possibility reported in the literature was through a transsellar route. The embryologic basis of the transsellar carotid route was suspected to be from persistence and fusion of primitive maxillary arteries. Normally, the primitive maxillary artery is present in early development and then regresses to the posteroinferior hypophyseal artery. It usually arises from the medial surface of the vertical portion of the carotid siphon and supplies the posterior hypophysis. It may arise from a common trunk together with the trigeminal artery; their common remnant will then be a single artery that arises from the vertical portion of the internal carotid siphon, the meningohypophyseal trunk.

The patient’s occluded proximal right middle cerebral artery was coupled with a well-developed anastomotic network to reconstitute the distal right middle cerebral artery. This probably represented an atresia with the persistent primitive plexiform network. The rich collateral network would favor a congenital etiology and was classified as a Moyamoya phenomenon with its localized involvement. There were 10 other cases reported in the literature, but this case was unique in its association with the solitary internal carotid artery.6,7

Conclusion

To our knowledge, this case of a solitary internal carotid artery associated with an ipsilateral middle cerebral artery Moyamoya phenomenon represents the first to appear in the literature. This anatomic variant would be of clinical significance in cases of surgical or endovascular intervention.

References

  1. ↵
    Ito S, Miyazaki H, Iino N, et al. Unilateral agenesis and hypoplasia of the internal carotid artery: a report of three cases. Neuroradiology 2005;47:311–15
    PubMed
  2. ↵
    Lee JH, Oh CW, Lee SH, et al. Aplasia of the internal carotid artery. Acta Neurochir (Wien) 2003;145:117–25
    CrossRefPubMed
  3. Nakai H, Kawata Y, Aizawa S, et al. Unilateral agenesis of the internal carotid artery in a patient with ruptured aneurysm of the anterior communicating artery: a case report [in Japanese]. No Shinkei Geka 1992;20:893–98
    PubMed
  4. Sato K, Yamada M, Sagiuchi T, et al. Aplasia of the right internal carotid arterypresenting with callosal hemorrhage: case report and review of the literature [in Japanese]. No Shinkei Geka 2005;33:613–17
    PubMed
  5. ↵
    Yoshida Y, Tochinai H, Murakami M, et al. A case of absence of the left internal carotid artery associated with aneurysm of the anterior communicating artery [in Japanese]. No Shinkei Geka 1988;16:1089–94
    PubMed
  6. ↵
    Matsumoto H, Moriwaki H, Masuo O, et al. Agenesis of the right internal carotid artery associated with complicated anastomosis of the middle cerebral artery: a case report [in Japanese]. No Shinkei Geka 2000;28:541–46
    PubMed
  7. ↵
    Seki Y, Fujita M, Mizutani N, et al. Spontaneous middle cerebral artery occlusion leading to moyamoya phenomenon and aneurysm formation on collateral arteries. Surg Neurol 2001;55:58–62
    CrossRefPubMed
  • Received September 26, 2005.
  • Accepted after revision October 27, 2005.
  • Copyright © American Society of Neuroradiology
View Abstract
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 27 (9)
American Journal of Neuroradiology
Vol. 27, Issue 9
October 2006
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
A Rare Anatomic Variant of a Solitary Internal Carotid Artery Associated with Moyamoya Phenomenon of the Middle Cerebral Artery
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
A Rare Anatomic Variant of a Solitary Internal Carotid Artery Associated with Moyamoya Phenomenon of the Middle Cerebral Artery
G.K.C. Wong, S.C.H. Yu, G.E. Antonio, W.S. Poon
American Journal of Neuroradiology Oct 2006, 27 (9) 2012-2013;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
A Rare Anatomic Variant of a Solitary Internal Carotid Artery Associated with Moyamoya Phenomenon of the Middle Cerebral Artery
G.K.C. Wong, S.C.H. Yu, G.E. Antonio, W.S. Poon
American Journal of Neuroradiology Oct 2006, 27 (9) 2012-2013;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Case Report
    • Discussion
    • Conclusion
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Usefulness of Quantitative Susceptibility Mapping for the Diagnosis of Parkinson Disease
  • White Matter Alterations in the Brains of Patients with Active, Remitted, and Cured Cushing Syndrome: A DTI Study
  • Qualitative and Quantitative Analysis of MR Imaging Findings in Patients with Middle Cerebral Artery Stroke Implanted with Mesenchymal Stem Cells
Show more BRAIN

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2022 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2023 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire