Abstract:

We present a case of an asymptomatic chronic middle cerebral artery (MCA) occlusion that was incidentally detected on transcranial color-coded sonography (TCCS) and confirmed by magnetic resonance angiography (MRA). Besides the presence of accelerated blood flow velocity in the ipsilateral anterior cerebral artery (ACA) and posterior cerebral artery (PCA), which is known as signs of pial collaterals, TCCS specifically visualized some deep anastomoses and new vessels running along the occluded MCA stem course. Therefore, TCCS showed transcortical collaterals indirectly and deep anastomoses and neovascularization directly, providing at least as much information as MRA in explaining patient’s lack of symptoms and predicting his outcome. However, during TCCS procedures, we should be aware of the possibility of mistaking neovascularization as a patent MCA stem, tortuous MCA, or indistinct MCA influenced by poor temporal bone window.

Key words: Middle cerebral artery; Transcranial color-coded sonography; Occlusion; Collaterals