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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2022; 32(02): 266-269
DOI: 10.1055/s-0042-1744231
Case Report

Hyperplastic Anterior Choroidal Artery—A Rare Variant Detected on MR Angiography

Ankita U. Shah
1   Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
,
Anagha R. Joshi 
1   Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
,
Pareekshith R. Rai 
1   Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
,
Pratik Kapse
1   Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Abstract

Introduction The anterior choroidal artery is a branch of the terminal internal carotid artery (ICA) that is often an incidentally detected anomaly. The hyperplastic variant has been linked with an increased risk of aneurysms. We explore the role of magnetic resonance (MR) angiography in the detection of this variant and its impact of presentation of patients.

Patient Presentation A 62-year-old diabetic and hypertensive male came to the casualty with complaints of giddiness, left-sided weakness, and loss of coordination for the last 2 to 3 days. He was provisionally diagnosed with a posterior circulation stroke.

Management and Outcome Magnetic resonance imaging of brain revealed an acute infarct in the right thalamus and the midbrain. Time-of-flight angiography sequences were done that showed hypoplasia of the A1 segment of the left anterior cerebral artery, fetal origin of the right posterior cerebral artery, narrowing of the left ICA, and a hyperplastic left anterior choroidal artery. He was managed conservatively with antiplatelets. He later underwent a digital subtraction angiography that revealed significant narrowing of the left ICA for which he was advised carotid stenting. However, the patient was unwilling for the procedure and was discharged on oral medication with stable vitals.

Conclusion Anatomical variations in the intracranial vasculature impact ischemia territory and the approach to intracranial pathology. Hyperplastic anterior choroidal artery results from the abnormal persistence of fetal pattern of vascular supply. It is important to recognize the presence of a hyperplastic anterior choroidal artery as it impacts both disease presentation and management of these patients. MR angiography allows for noninvasive and reliable detection of these anomalies in patients without the risks associated with radiation or contrast exposure in conventional/computed tomography angiography.

Keywords

anatomical variations - hyperplastic anterior choroidal artery - MR angiography

Authors' Contributions

Ankita Shah was involved in data collection and manuscript preparation and review. Anagha Joshi prepared and reviewed the manuscript. Pareekshith R. Rai and Pratik Kapse contributed in data collection and manuscript preparation.




Publication History

Article published online:
09 June 2022

© 2022. Indian Radiological Association. 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 commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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