Bilateral carotid and vertebral rete mirabile with aneurysm misdiagnosed as Moyamoya disease: A case report.

RATIONALE: Rete mirabile (RM) is rare in humans, normally existing in lower mammalian arteries. To study its clinical and imaging features, we report an extremely rare case that occurred in humans and review the literature.

PATIENT CONCERNS: A 43-year-old female patient was admitted to our hospital because of recurrent dizziness and headache for 4 years.

DIAGNOSES: The computed tomography angiography (CTA) of the head and neck indicated that the normal structure of the bilateral cervical and vertebral arteries disappeared, and the microvascular network formed, misdiagnosed as Moyamoya disease.

INTERVENTIONS: She underwent cerebral digital subtraction angiography examination and was finally diagnosed as carotid and vertebral RM with aneurysm.

OUTCOMES: Following the administration of symptomatic treatment, all of her symptoms dissipated, and she was successfully discharged from the hospital.

LESSONS: RM involving in both anterior and posterior circulation is an extremely rare clinical abnormality of cerebrovascular morphology. The radiologists and clinicians should deepen their awareness of the specific CTA feature of RM. When individual CTA examination is insufficient, the utility of digital subtraction angiography is crucial for making a clear diagnosis.