Variants of anomalies in the structure of the Willis circle in patients with acute cerebrovascular accident in various vascular beds

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Abstract

Background. The frequency and severity of acute cerebrovascular accident depend on the variants of the anomaly in the structure of the Willis circle.

Aim. To identify the frequency and variants of the Willis circle anomaly in patients with acute cerebrovascular accident with an assessment of the severity of neurological disorders according to the National Institutes of Health Stroke Scale (NIHSS).

Material and methods. The study included 47 patients with acute cerebrovascular accident in conditions of the Willis circle anomaly: 21 male and 26 female, mean age was 67.08±16.03 years. All patients underwent magnetic resonance imaging, magnetic resonance angiography of the brain, neurological examination using NIHSS.

Results. Patients with the absence of one posterior communicating artery had a significant stroke severity according to the NIHSS: 9.429±5.840 points (moderate neurological disorders), p=0.016. The results in patients with the absence of both posterior communicating arteries were 5.667±4.410 (p=0.939), in patients with posterior trifurcation 5.200±6.058 (p=0.864), the group with an anomaly in the form of the absence of all communicating arteries had 4.000±2.828 points (mild neurological disorders), p=0.602. The group of patients with anterior trifurcation showed the lowest results: 3.500±2.121 points (p=0.492). Circulatory disorders in the posterior circulation system were significantly more common in the pathologies of the Willis circle consisting of trifurcation, and less common in other pathologies of the Willis circle, consisting in trifurcation, compared with the group of patients with the absence of at least one communicating artery (p=0.037).

Conclusion. Patients with stroke and the absence of one posterior communicating artery had neurological disorders of moderate severity according to the NIHSS, with the localization of the catastrophe mainly in the left middle cerebral artery circulation; in patients with the absence of both posterior communicating arteries, neurological disorders were of mild severity; patients with stroke in the posterior circulation system more often had an anomaly of the Willis circle in the form of a trifurcation.

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About the authors

Svetlana K. Perminova

City Clinical Hospital No. 7

Author for correspondence.
Email: sveta1perminova@yandex.ru
ORCID iD: 0000-0001-6641-8432

M.D., Cand. Sci. (Med.), neurologist, Depart. for the treatment of patients with Stroke

Russian Federation, Kazan, Russia

Aida A. Yakupova

Kazan State Medical University

Email: aidayakupova@yandex.ru
ORCID iD: 0000-0002-5283-8820

M.D., D. Sci. (Med.), Assoc. Prof., Depart. of neurology and neurosurgery

Russian Federation, Kazan, Russia

References

  1. Vilenskiy BS. Insul't: profilaktika, diagnostika i lechenie. (Stroke: prevention, diagnosis and treatment.) 2nd ed., add. St. Petersburg: Foliant; 2002. 397 p. (In Russ.)
  2. Gusev EI, Konovalov AN, Skvortsova VI. Nevrologiya i neyrokhirurgiya. (Neurology and neurosurgery.) Vol. 1. 2nd ed., ispr. and add. M.: GEOTAR-Media; 2007. 608 p. (In Russ.)
  3. Standring S, editor. Gray's Anatomy: The Anatomical basis of clinical practice. 39th ed. New York, NY: Elsevier, Churchill Livingstone; 2005. р. 403–410.
  4. McKinney AM. Intracranial anterior circulation variants. Atlas of normal imaging variations of the brain, skull, and craniocervical vasculature. Springer International Pubblishing Switzerland; 2017. р. 1065–1103. doi: 10.1007/978-3-319-39790-0_37.
  5. Rhoton А. Cranial anatomy and surgical approaches. Philadelphia: Lippincott Williams & Wilkins; 2007. 746 р.
  6. Jmurkin VP, Chalova VV. The history of extraordinary book by T. Willis (1621–1675): to 350th anniversary of first edition of book “cerebri anatome”. Problemy sotsialnoy gigieny, zdravookhraneniya i istoriya meditsiny. 2014;(5):56–61. (In Russ.)
  7. Frank RG. Thomas Willis and his circle: brain and mind in seventeenth century medicine. The Languages of Psyche. Rousseau G, editor. Berkeley: University of California Press; 1990. р. 107–146. doi: 10.1525/9780520910430-008.
  8. Putsillo MV, Vinokurov AG, Belov AI. Atlas neyrokhirurgicheskoy anatomii. T. 1. (Atlas of neurosurgical anatomy. Vol. 1.) Konovalov AN, editor. M.: Antidor; 2002. 206 p. (In Russ.)
  9. Trushel NA. The variants of anatomy of circle of Willis. Zhurnal anatomii i gistopatologii. 2015;4(3):120–121. (In Russ.)
  10. Trushel NA. Variants of the non-classical structure of the arterial circle of the large brain. Meditsinskiy zhurnal. 2011;(1):104–106. (In Russ.)
  11. Harold EV, Murlimanju B, Shrivastava A, Yeider AD, Andrei F, Ezequiel G, Luis R, Agrawal A. Intracranial collateral circulation and its role in neurovascular pathology. Egyptian Journal of Neurosurgery. 2021;36:2–4. doi: 10.1186/s41984-020-00095-6.
  12. Trushel NA. Нemodynamic and morphological preconditions of cerebrovascular pathology development. Zhurnal anatomii i gistopatologii. 2016;5(4):69–73. (In Russ.)
  13. Brust JCM, Chamorro A. Anterior cerebral artery disease. Stroke. 2016;e8:347–361. doi: 10.1016/B978-0-323-29544-4.00023-2.

Supplementary files

Supplementary Files
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1. Рис. 1. Пациент В., передняя трифуркация левой внутренней сонной артерии, магнитно-резонансный сигнал от правой задней соединительной артерии отсутствует, низкоинтенсивный сигнал от правой передней мозговой артерии

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2. Рис. 2. Пациент В., очаг ишемии в области моста (вертебробазилярный бассейн)

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