Incidental discovery of an azygos-type anterior cerebral artery in a cluster headache patient: a case report

Authors

DOI:

https://doi.org/10.37085/nsa.2024.7

Keywords:

Azygos ACA, Anterior cerebral artery, Cluster headache, MRI, Angiography, Pain

Abstract

Introduction
Intracranial arterial variations are prevalent and do not necessarily compromise cerebral blood flow. These variations, including the persistence of embryonic features like the fetal posterior cerebral artery pattern from the internal carotid artery, are commonly found during neuroradiological evaluation and noted in neurological assessments for symptoms like headaches and dizziness. Primary headaches such as cluster headaches require differential diagnosis to exclude organic causes like parasellar lesions, which mimic their presentation. In this article, we aim to report a case of an adult patient who experienced a typical episode of cluster headache, and during the radiological investigation, we identified the presence of an azygos-type anterior cerebral artery (possibly unrelated to the trigeminal autonomic cephalalgia).
Case report
This article presents a case of a 73-year-old male experiencing severe, right-sided orbital-fronto-parietal headaches at age 45, diagnosed as cluster headaches. Accompanied by tearing and redness of the right eye, episodes lasted 30-60 minutes, and agitation. Despite the pain's intensity, oxygen therapy provided relief. Recent MRI scans, prompted by two months of dizziness, revealed an azygos anterior cerebral artery without other abnormalities, highlighting a rare anatomical variant.
Conclusion
In conclusion, we have presented a case involving a patient with a history of cluster headaches who, upon undergoing MRI evaluation, was discovered to have an azygos-type anterior cerebral artery. Considering the uncommon nature of this anatomical variation, we believe it is crucial to report and document this finding.

References

Gunnal SA, Farooqui MS, Wabale RN. Study of Middle Cerebral Artery in Human Cadaveric Brain. Ann Indian Acad Neurol. 2019;22(2):187-94. Doi 10.4103/0972-2327.144289 DOI: https://doi.org/10.4103/0972-2327.144289

Gunnal SA, Farooqui MS, Wabale RN. Study of Posterior Cerebral Artery in Human Cadaveric Brain. Anat Res Int. 2015;2015:681903. Doi 10.1155/2015/681903 DOI: https://doi.org/10.1155/2015/681903

Niederberger E, Gauvrit JY, Morandi X, Carsin-Nicol B, Gauthier T, Ferre JC. Anatomic variants of the anterior part of the cerebral arterial circle at multidetector computed tomography angiography. J Neuroradiol. 2010;37(3):139-47. Doi 10.1016/j.neurad.2009.12.004 DOI: https://doi.org/10.1016/j.neurad.2009.12.004

Silva Neto AR, Camara RL, Valenca MM. Carotid siphon geometry and variants of the circle of Willis in the origin of carotid aneurysms. Arq Neuropsiquiatr. 2012;70(12):917-21. Doi 10.1590/s0004-282x2012001200003 DOI: https://doi.org/10.1590/S0004-282X2012001200003

Yokus A, Toprak N, Gunduz AM, Akdeniz H, Akdemir Z, Dundar I, et al. Anterior Cerebral Artery and Anterior Communicating Artery Variations: Assessment with Magnetic Resonance Angiography. World Neurosurg. 2021;155:e203-e9. Doi 10.1016/j.wneu.2021.08.027 DOI: https://doi.org/10.1016/j.wneu.2021.08.027

Medrano-Martorell S, Pumar-Perez M, Gonzalez-Ortiz S, Capellades-Font J. A review of the anatomy of the middle cerebral artery for the era of thrombectomy: A radiologic tool based on CT angiography and perfusion CT. Radiologia (Engl Ed). 2021;63(6):505-11. Doi 10.1016/j.rxeng.2021.10.004 DOI: https://doi.org/10.1016/j.rxeng.2021.10.004

Grand W. Microsurgical anatomy of the proximal middle cerebral artery and the internal carotid artery bifurcation. Neurosurgery. 1980;7(3):215-8. Doi 10.1227/00006123-198009000-00002 DOI: https://doi.org/10.1227/00006123-198009000-00002

Blackburn IW. On the median anterior cerebral artery as found among the insane. Journal of Comparative Neurology and Psychology. 1910;20(3):185-94. DOI: https://doi.org/10.1002/cne.920200303

The Azygos Anterior Cerebral Artery [Radiology Key]. Available from: https://radiologykey.com/12-the-azygos-anterior-cerebral-artery/#:~:text=Embryologically%2C%20the%20azygos%20vessel%20appears,20%E2%80%9324%2Dmm%20stage.

Gunnal SA, Wabale RN, Farooqui MS. Variations of anterior cerebral artery in human cadavers. Neurolology Asia. 2013;18(3):249 – 59.

Valenca MM, Andrade-Valenca LP, Martins C, de Fatima Vasco Aragao M, Batista LL, Peres MF, et al. Cluster headache and intracranial aneurysm. J Headache Pain. 2007;8(5):277-82. Doi 10.1007/s10194-007-0412-9 DOI: https://doi.org/10.1007/s10194-007-0412-9

Valença MM, Silva AHTTd, Mendes RFdA, Andrade PHPd, Silva UAVd, Carvalho DEd, et al. Incidental intracranial saccular aneurysm in a patient with post-Covid-19 headache: What to do with the incidentaloma? Headache Medicine. 2021;12(1):64-8. Doi 10.48208/HeadacheMed.2021.13 DOI: https://doi.org/10.48208/HeadacheMed.2021.13

Mesquita Sousa Santos PE, Gabriela Figueiredo P, Juliana A. Vertebral artery hypoplasia and chronic migraine: is there an association or just an incidental finding? Headache Medicine. 2021;12(2):148-51. Doi 10.48208/HeadacheMed.2021.27 DOI: https://doi.org/10.48208/HeadacheMed.2021.27

Sibiya G, Omotoso BR, Harrichandparsad R, Lazarus L. Exploring the anatomical configurations of the cerebral arteries in a cohort of South African patients. Sci Rep. 2024;14(1):6060. Doi 10.1038/s41598-024-56767-y DOI: https://doi.org/10.1038/s41598-024-56767-y

Paraskevas GK, Koutsouflianiotis KN, Patsikas M, Noussios G. What is the history of the term "azygos vein" in the anatomical terminology? Surg Radiol Anat. 2019;41(10):1155-62. Doi 10.1007/s00276-019-02238-3 DOI: https://doi.org/10.1007/s00276-019-02238-3

Beyhan M, Gokce E, Karakus K. Radiological classification of azygos anterior cerebral artery and evaluation of the accompanying vascular anomalies. Surg Radiol Anat. 2020;42(11):1345-54. Doi 10.1007/s00276-020-02509-4 DOI: https://doi.org/10.1007/s00276-020-02509-4

Baptista AG. Studies on the Arteries of the Brain. Ii. The Anterior Cerebral Artery: Some Anatomic Features and Their Clinical Implications. Neurology. 1963;13:825-35. Doi 10.1212/wnl.13.10.825 DOI: https://doi.org/10.1212/WNL.13.10.825

Perlmutter D, Rhoton AL, Jr. Microsurgical anatomy of the distal anterior cerebral artery. J Neurosurg. 1978;49(2):204-28. Doi 10.3171/jns.1978.49.2.0204 DOI: https://doi.org/10.3171/jns.1978.49.2.0204

Binatli O, Ozer F, Aydin M, Cicek E, Binatli Y. Azygos anterior cerebral artery aneurysm with concomittant vascular anomaly: case report. World J Neurosci 2013;3:49-51. Doi 10.4236/wjns.2013.31006 DOI: https://doi.org/10.4236/wjns.2013.31006

Singh H, Dhandapani S, Mathuriya SN. Types of Azygos Distal Anterior Cerebral Artery Branching Patterns: Relevance in Aneurysmal Surgery. Cureus. 2016;8(7):e681. Doi 10.7759/cureus.681 DOI: https://doi.org/10.7759/cureus.681

Watts JW. A Comparative Study of the Anterior Cerebral Artery and the Circle of Willis in Primates. J Anat. 1934;68(Pt 4):534-50.

Downloads

Published

2024-03-29

How to Cite

Valença, M. M., Valença, M. F., Monteiro, J. dos S., Martins, C., & Batista, L. L. (2024). Incidental discovery of an azygos-type anterior cerebral artery in a cluster headache patient: a case report. Neurological Surgery and Anatomy, 1(1), 29–33. https://doi.org/10.37085/nsa.2024.7

Issue

Section

Case report