Although both accessory middle cerebral artery (MCA) and accessory anterior cerebral artery (ACA) are not rare anatomical variations, their combination is rare and there are only a limited number of reports of such combinations.

We report a case of accessory MCA associated with an accessory ACA diagnosed by magnetic resonance angiography (MRA).

A 39-year-old woman visited our hospital because of right facial discomfort. She underwent 1.5-Tesla magnetic resonance imaging and MRA. MRA showed a left accessory MCA originating from the left ACA A1 segment. MRA also showed an accessory ACA that formed a triplicated ACA at its A2 segment.

Careful imaging assessment is important to identify multiple anatomical variations such as an accessory MCA associated with an accessory ACA. In our case, this rare anatomical variation was confirmed by 1.5-Tesla MRA.