Case Notes
History
36 yo female with 2 week history of intermittent weakness on both sides, numbness epsodes lasting 4 hours & word finding difficulty.Exam
MR T1-w pre contrast
Prior Study
CT HeadNegative study for acute arterial or venous occlusion. But, there is focal mural wall calcification in the subclinoidal right ICA with the potential for causing a flow-limitng stenosis.
There is a small completed lacunar infarct in the left caudate head.
The combination of a completed stroke and mild global atrophy and prominent basal ganglia calcificiation suggests the presence of underlying vasculopathy.
CT Perfusion
CT perfusion and CTA evidence of moyamoya disease with expected alteration of blood flow, as above.
Small completed infarct in the left caudate head.
CTA neck
Arterial vascular changes consistent with moyamoya disease.
Focal vascular calcification in the extradural ICA segment on the right producing a flow-limiting stenosis.
CTA head
1. Evidence of moyamoya disease vasculopathy
2. There is a prior small completed lacunar stroke in the left caudate head.
3. There is delayed filling of distal MCA pial arteries on the right.
Post contrast CT head
1. The brain CT density within the venocapillary pool is essentially normal, despite the delayed pial filling in the right MCA on the CTA head.
2. There are two small areas of persistent oligemia in the caudate head on the left and basifrontal white matter on the right. Both are likely sites of previous ischemic injury.
3. The classic features of moyamoya disease are again evident.