□ PICTURES IN CLINICAL MEDICINE □

Intravenous t-PA for the Occlusion of an Accessory MCA
Hiroya Kuwahara, Ken Matsumura, Mutsufusa Watanabe and Hiroto Fujigasaki
Key words: intravenous tissue plasminogen activator, accessory middle cerebral artery, magnetic resonance
angiography, cerebral angiography
(Intern Med 52: 163, 2013)
(DOI: 10.2169/internalmedicine.52.8999)

potential causes of ischemic stroke were identified, such as
cardiovascular disturbances or coagulation disorders.
An accessory MCA is an anomalous vessel originating
from the anterior cerebral artery. The frequency of this
anomaly is reported to range from 0.3% to 4.0% (1). Aneurysms are an occasional complication of accessory
MCAs (2), but ischemic strokes associated with this type of
artery are extremely rare (3, 4). Thrombosis might have
been induced by blood turbulence in the proximal portion of
the accessory MCA in our patient.
The authors state that they have no Conflict of Interest (COI).
Acknowledgement
We thank Dr. Keiko Nakamura (Junior resident, Tokyo Metropolitan Bokutoh Hospital) and Dr. Kazuo Hanakawa (Department
of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital) for their
valuable clinical assistance.

References

Picture.

A 27-year-old man suddenly developed severe left hemiplegia and dysarthria. Magnetic resonance angiography
showed the occlusion of the right accessory middle cerebral
artery (MCA) (Picture A). The symptoms fully recovered after the intravenous administration of tissue plasminogen activator (t-PA). Cerebral angiography performed after the treatment revealed recanalization of the artery (Picture B). No

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Department of Neurology, Tokyo Metropolitan Bokutoh Hospital, Japan
Received for publication October 1, 2012; Accepted for publication October 9, 2012
Correspondence to Dr. Hiroya Kuwahara, h-kuwahara.nuro@tmd.ac.jp
Ⓒ 2013 The Japanese Society of Internal Medicine
Journal Website: http://www.naika.or.jp/imonline/index.html

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