Middle cerebral artery fenestration presenting with cerebral ischemia: a case report and review of the literature

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MCA fenestration is a rare vascular variant that can mimic stenosis and is associated with cerebral ischemia, though its relationship remains controversial.
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A case study of a 53-year-old man revealed MCA fenestration diagnosed via DSA and HRMR-VWI, initially misidentified as left MCA occlusion.
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The literature review identified 19 cases of MCA fenestration associated with cerebral ischemia, predominantly affecting males aged 4 to 85 years.
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Slit-like morphology in MCA fenestration was linked to a higher risk of acute ischemic stroke, with favorable outcomes in 73.7% of patients.
5

Multimodal imaging, including HRMR-VWI and PWI, is crucial for accurate diagnosis and management of MCA fenestration to prevent misdiagnosis.

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