Twig-Like Middle Cerebral Artery: A Rare Cause of Pediatric Stroke That Mimics Moyamoya Disease

A twig-like middle cerebral artery is a rare vascular anomaly that presents with cerebral infarction, transient ischemic attack, headache, seizures, and intracerebral hemorrhage. It can be mistaken for unilateral moyamoya disease and focal cerebral arteriopathy of the inflammatory type. Recognizing this distinction is vital for guiding monitoring and stroke prevention strategies. Overall, the twig-like middle cerebral artery is a rare condition, but it has been reported more frequently in adults than in children. Because of its rarity, the diagnosis is often missed, making it crucial to raise awareness about this entity. We report a case of a twig-like middle cerebral artery presenting as a stroke in an infant, initially misdiagnosed as moyamoya disease. This is the first report of a twig-like middle cerebral artery in an infant. Relevant literature is reviewed in the discussion.