{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:59:15Z","timestamp":1780981155116,"version":"3.54.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Middle cerebral artery (MCA) fenestration is a rare vascular variant that can mimic stenosis. Its association with cerebral ischemia remains controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We report the case of a 53-year-old man with a history of transient ischemic attack (TIA), initially misdiagnosed with left MCA occlusion, who presented with sleep disturbances due to fear of stroke recurrence. A definitive diagnosis of MCA fenestration was established by digital subtraction angiography (DSA) and high-resolution magnetic resonance vessel-wall imaging (HRMR-VWI). Perfusion-weighted imaging (PWI) was employed to evaluate the associated hemodynamic compromise. A literature review was conducted to identify all reported cases of MCA fenestration associated with cerebral ischemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 19 cases (including ours) from 12 studies were identified. Patients were predominantly male, with ages ranging from 4 to 85\u202fyears. All fenestrations were located in the M1 segment. Slit-like morphology was observed in 73.7% of patients and was more frequent in acute ischemic stroke (AIS) than in TIA (91.7% vs. 42.9%). Eleven patients (57.9%) were definitively diagnosed via DSA. Mechanical thrombectomy was performed in six patients with concurrent MCA occlusion, yielding favorable functional outcomes in five (83.3%). Overall, 73.7% of patients achieved favorable outcomes at follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MCA fenestration should be considered in the differential diagnosis for patients presenting with cerebral ischemia and M1 stenosis or occlusion, particularly in the absence of conventional vascular risk factors. A slit-like morphology may be associated with a higher risk of stroke. Multimodal imaging is essential to avoid misdiagnosis and guide appropriate clinical management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1879070","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:30:17Z","timestamp":1780979417000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Middle cerebral artery fenestration presenting with cerebral ischemia: a case report and review of the literature"],"prefix":"10.3389","volume":"13","author":[{"given":"Ying","family":"Bi","sequence":"first","affiliation":[{"name":"Department of Neurology, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]},{"name":"Hubei Provincial Clinical Research Center for Dementia and Cognitive Impairment, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhifang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]},{"name":"Hubei Provincial Clinical Research Center for Dementia and Cognitive Impairment, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxian","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurology, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]},{"name":"Hubei Provincial Clinical Research Center for Dementia and Cognitive Impairment, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Neurology, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]},{"name":"Hubei Provincial Clinical Research Center for Dementia and Cognitive Impairment, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huagang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]},{"name":"Hubei Provincial Clinical Research Center for Dementia and Cognitive Impairment, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Mei","sequence":"additional","affiliation":[{"name":"Department of Neurology, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]},{"name":"Hubei Provincial Clinical Research Center for Dementia and Cognitive Impairment, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, 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