# Twig-Like Middle Cerebral Artery Anomaly Mimicking Vaso-Occlusion Disease: A Rare Neuroimaging Finding

## TL;DR

A rare vascular anomaly in the brain mimicked a stroke, highlighting the need to recognize such variants to avoid misdiagnosis.

## Contribution

This case highlights the twig-like MCA as a rare vascular variant that can mimic vaso-occlusive disease on imaging.

## Key findings

- CT angiography revealed a plexiform vascular network in the M1 segment of the right MCA.
- Digital subtraction angiography confirmed a non-progressive twig-like lesion with no cerebral infarction.
- Conservative treatment was sufficient, emphasizing the benign nature of this vascular variant.

## Abstract

Rete MCA, or the twig-like middle cerebral artery (tMCA), is a rare congenital vascular malformation that can mimic vaso-occlusive processes in advanced imaging. We present the case of a 52-year-old man who developed weakness in his left arm and neck pain due to a wound after being beaten by individuals. Non-contrast computed tomography (CT) was used to assess the cervical and craniofacial injuries. CT angiography showed a plexiform vascular network supplying the area of the M1 segment of the right MCA, with no evidence of remote collateral circulation or cerebral infarction. Our case was further delineated using digital subtraction angiography, and it revealed a non-progressive twig-like lesion on the right MCA. The patient was treated conservatively. This case points to the potential for a twig-like MCA to mimic vascular emergencies and re-emphasizes the importance of recognizing a tMCA as an innocuous vascular variant that can mimic pathological processes, which may change the interpretation of any future advanced imaging and treatment options.