In Collaboration with Dr. Eytan Raz
A tortuous, usually moderately fusiformly dilated, frequently calcified anterior cerebral artery, particularly at pericalossal and distal A2 segments, is a rare but characteristic finding. Sometimes mistaken for an AVM on cross-sectional imaging, the lesion shows no arteriovenous shunting, but is almost always associated with adjacent cortical dysplasia. The latter can be subtle and frequently there are no seizures or other clinical issues. The finding is typically asymptomatic. Literature is understandably limited but relatively consistent in portraying it as an incidental finding.
Case 1 — chronic headaches, normal exam
Calcification on susceptibility imaging
Subtle adjacent cortical dysplasia
Same on coronal T1 post
Typical angio appearance — tortuous, fusiform A2/Pericalossal, without arteriovenous shunting
Red/cyan anaglyph stereo
Native stereos, retro style
Usually the finding is bilateral, as it is here (see unilateral Case 4 below)
Case 2 — young woman with syncope. Normal exam. Typical calcifications
Less subtle cortical dysplasia
Angio. Less obvious but real ACA findings
Case 3 — incidental finding.
As in anything, there is a spectrum of findings. Case of short segment dolichoectasia.
Case 4 — unilateral dolichoectasia. Why not? Could it be a dissection — theoretically yes but given overall appearance i think no.
Very much not subtle dysplasia, unilateral.
Angio normal on left
Not normal on right
Conclusions — characteristic appearance. Dont mistake it for a fistula. If unsure angio will solve the dilemma. Look for adjacent cortical dysplasia.
Etiology — unknown. May be part of “Pure arterial vascular anomalies” — see https://www.ncbi.nlm.nih.gov/pubmed/28960150