2024 Volume 46 Issue 5 Pages 355-359
A 56-year-old woman experienced a thunderclap headache after swimming. Cranial CT showed no new lesion except the old cerebral infarction. A few days later, the headache did not improve and she was examined again. MRI showed a similar old infarction as demonstrated by the CT. MRA showed an obscure image of MCA. The headache continued, and a repeated MRI showed a new cerebral infarction and she was hospitalized. A duplicated MCA was shown by cerebral angiography. Another vessel with irregular stenoses proved to be the main MCA. The diagnosis was profoundly confused because we misunderstood the duplicated MCA as a single MCA in the early clinical course. The headache and a new cerebral infarction had a possibility to be caused by dissection of the main MCA trunk. A normal variation of the MCA should be considered when we encounter with atypical headache and infarction.
