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Journal of the Korean Child Neurology Society 2011;19(3):231-239.
Published online December 30, 2011.
A1 Segment Hypoplasia/aplasia Detected by Magnetic Resonance Angiography in Neuropediatric Patients.
Yoon Ki Han, Seung Kim, Choon Sik Yoon, Young Mock Lee, Hoon Chul Kang, Joon Soo Lee, Heung Dong Kim
1Department of Pediatrics, Gangnam Severance Hospital, Severance Children's Hospital Yonsei University College of Medicine, Seoul, Korea. ymleemd@yuhs.ac
2Department of Radiology, Gangnam Severance Hospital Yonsei University College of Medicine, Seoul, Korea.
Abstract
PURPOSE
A variation in the circle of Willis is not so common, but the most frequent type is hypoplasia/aplasia of the precommunicating anterior cerebral arteries (A1 segment). We aimed to examine the incidence and the clinical significance of A1 segment hypoplasia/aplasia in neuropediatric patients. METHODS: We retrospectively studied children with A1 segment hypoplasia/aplasia in brain magnetic resonance angiography (MRA) and compared the clinical and radiological aspects between children with A1 segment hypoplasia/aplasia alone and with other variations in the circle of Willis. RESULTS: Among 301 patients, 34 patients (11.3%) had A1 segment hypoplasia/aplasia. They presented neurological symptoms such as chronic headache, dizziness and visual disturbance. Seven (20.6%) had family history of neurological illness. Twenty seven (79.4%) had A1 segment hypoplasia/aplasia only, and seven (20.6%) had another vascular abnormality. Seven (20.6%) showed abnormal brain magnetic resonance angiography (MRI) results, cerebral atrophy being the most frequent (n=5, 14.7%). The incidence of abnormal brain MRI was 11.1% (n=3) in single vascular abnormality and 57.1% (n=4), significantly higher (p-value 0.02) in combined abnormality group. CONCLUSION: Structural alterations in the cerebral vasculature in children have important pathophysiological and clinical implications. Evaluation of variations in the circle of Willis, especially of A1 segment hypoplasia/aplasia using MRA is recommended.
Key Words: Circle of Willis, A1 segment, Hypoplasia, Aplasia, Magnetic resonance angiography


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