Axillary arch: a unique entity

were weak, with muscle power grade 3 in the upper limbs and grade 4 in the lower limbs. Laboratory examination revealed no abnormalities in the serum hypercoagulable panel. Electrocardiography revealed normal sinus rhythm without arrhythmia. Computed tomography and magnetic resonance imaging (Fig. 1) confirmed the presence of a calcified tumour in the right and medial portion of the sphenoid ridge. The tumour compressed the first segment of the middle cerebral artery (MCA), thereby resulting in an acute thromboembolic MCA territory infarct. To prevent morbidity secondary to vascular injury, the patient underwent Simpson grade III resection through the pterional approach. The tumour was adherent to the surrounding frontal lobe and vessels, and the arachnoid membrane was not preserved. The vessel compression was resolved, but the hemiparesis persisted. The pathology revealed a psammomatous meningioma. After a 3-month rehabilitation programme, the patient recovered with mild paresis in the left upper extremity. Meningioma could result in acute infarction of the MCA as in the case of ICA and anterior cerebral artery. We suspect that hypoperfusion resulted from external compression by the meningioma, and artery-to-artery thromboembolization contributed to the pathophysiology of our patient’s hemiparesis. We also want to emphasize that in patients with acute infarction, the possibility of sphenoid ridge meningioma must be considered in the differential diagnosis.