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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(02): 181-182
DOI: 10.1590/0004-282X-anp-2020-0351
Images in Neurology

Rete middle cerebral artery: a rare variant

Artéria cerebral média rete: uma variante rara
Leonardo Deus-Silva 
1   Universidade Estadual de Campinas, Hospital de Clínicas, Departamento de Radiologia, Seção de Neurorradiologia Intervencionista, Campinas SP, Brazil.
2   Pontifícia Universidade Católica de Campinas, Hospital Celso Pierro, Neurorradiologia Intervencionista e Neurocirurgia Endovascular, Campinas SP, Brazil.
,
Livia de Oliveira 
2   Pontifícia Universidade Católica de Campinas, Hospital Celso Pierro, Neurorradiologia Intervencionista e Neurocirurgia Endovascular, Campinas SP, Brazil.
,
Luiz Gustavo de Abreu Mattos 
2   Pontifícia Universidade Católica de Campinas, Hospital Celso Pierro, Neurorradiologia Intervencionista e Neurocirurgia Endovascular, Campinas SP, Brazil.
,
André Luís Nunes Albano de Meneses 
1   Universidade Estadual de Campinas, Hospital de Clínicas, Departamento de Radiologia, Seção de Neurorradiologia Intervencionista, Campinas SP, Brazil.
2   Pontifícia Universidade Católica de Campinas, Hospital Celso Pierro, Neurorradiologia Intervencionista e Neurocirurgia Endovascular, Campinas SP, Brazil.
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A 29-year-old female presenting migraine-like headaches was found to have irregular vessels resembling a moyamoya[1] pattern involving the right middle cerebral artery (MCA). A digital cerebral angiography revealed the absence of a normal right M1 segment, with a tangle of serpiginous vessels connecting the carotid termination to a normal distal M1 ([Figure 1]). This structure is different from a moyamoya pattern and is likely related to the persistence of a fetal arterial network that eventually became the MCA main trunk[2] ([Figures 2] to [4]). This rare, so-called rete MCA pattern is a normal variant and should be recognized as such to avoid unnecessary interventions[3].

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Figure 1 Right internal carotid angiogram showing the absence of a normal middle cerebral artery with a rete pattern of vessels connecting the carotid termination to a normal distal M1.
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Figure 2 (A) 3D-rendered angiographic image in frontal view demonstrating contributions from the anterior cerebral artery (curved arrow) to the tangle of vessels reconstituting the distal M1 segment. (B) Lateral view of the same 3D image indicating the contribution of the anterior choroidal artery complex to the distal M1.
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Figure 3 Multiplanar reconstruction of rotational angiography showing the presence of lenticulostriate arteries (arrow) arising from the anomalous proximal rete middle cerebral artery.
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Figure 4 Frontal view of a vertebrobasilar angiogram demonstrating pial collaterals contributing to temporal and parietal vascular territories.

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Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med. 2009 Mar;360(12):1226-37. https://doi.org/10.1056/NEJMra0804622
  • 2 Cho KC, Kim JJ, Jang CK, Hong CK, Joo JY, Kim YB. Rete middle cerebral artery anomalies: a unifying name, case series, and literature review. J Neurosurg. 2018 Aug;131(2):453-61. https://doi.org/10.3171/2018.2.JNS1832
  • 3 Colombo E, Brinjikji W, Klaas J, Lanzino G. Teaching NeuroImages: Rete-like middle cerebral artery. Neurology. 2019 Nov;93(20):e1919-20. https://doi.org/10.1212/WNL.20200351202003518480

Address for correspondence

Leonardo Deus-Silva

Publication History

Received: 20 July 2020

Accepted: 12 August 2020

Article published online:
04 July 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med. 2009 Mar;360(12):1226-37. https://doi.org/10.1056/NEJMra0804622
  • 2 Cho KC, Kim JJ, Jang CK, Hong CK, Joo JY, Kim YB. Rete middle cerebral artery anomalies: a unifying name, case series, and literature review. J Neurosurg. 2018 Aug;131(2):453-61. https://doi.org/10.3171/2018.2.JNS1832
  • 3 Colombo E, Brinjikji W, Klaas J, Lanzino G. Teaching NeuroImages: Rete-like middle cerebral artery. Neurology. 2019 Nov;93(20):e1919-20. https://doi.org/10.1212/WNL.20200351202003518480

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Zoom Image
Figure 1 Right internal carotid angiogram showing the absence of a normal middle cerebral artery with a rete pattern of vessels connecting the carotid termination to a normal distal M1.
Zoom Image
Figure 2 (A) 3D-rendered angiographic image in frontal view demonstrating contributions from the anterior cerebral artery (curved arrow) to the tangle of vessels reconstituting the distal M1 segment. (B) Lateral view of the same 3D image indicating the contribution of the anterior choroidal artery complex to the distal M1.
Zoom Image
Figure 3 Multiplanar reconstruction of rotational angiography showing the presence of lenticulostriate arteries (arrow) arising from the anomalous proximal rete middle cerebral artery.
Zoom Image
Figure 4 Frontal view of a vertebrobasilar angiogram demonstrating pial collaterals contributing to temporal and parietal vascular territories.