Color-coded digital subtraction angiography in the management of a rare case of middle cerebral artery pure XXXX . A technical and case report.

@entity1 @entity390 @entity2500 @entity3791 @entity391 @entity600 @entity439 @entity432 @entity21915 @entity10
The advent of flow dynamics and the recent availability of perfusion analysis software have provided new diagnostic tools and management possibilities for cerebrovascular @entity1 . To this end, we provide an example of the use of color-coded angiography and its application in a rare case of a @entity1 with a pure @entity2500 . A 42-year-old male chronic smoker was evaluated in the emergency room due to sudden onset of severe @entity10 , @entity390 , @entity391 and left-sided weakness. Head computed tomography revealed a right @entity21915 . Cerebral digital subtraction angiography (DSA) showed a right middle cerebral @entity600 consisting of convoluted and ectatic collateral vessels supplying the distal middle cerebral artery territory-M1 proximally occluded. An associated medial lenticulostriate artery @entity439 was found. Brain single-photon emission computed tomography with and without @entity3791 failed to show problems in vascular reserve that would indicate the need for flow augmentation. Twelve months after discharge, the @entity1 recovered from the left-sided weakness and did not present any similar events. A follow-up DSA and perfusion study using color-coded perfusion analysis showed perforator @entity439 resolution and adequate, albeit delayed perfusion in the involved vascular territory. We propose a combined congenital and acquired mechanism involving @entity432 with secondary dysplastic changes in collateral supply to the distal MCA territory. Angiographic and cerebral perfusion work-up was used to exclude the need for flow augmentation. Nevertheless, the natural course of this lesion remains unclear and long-term follow-up is warranted.
