PMC3261594_01
(a) DWI/ADC MR images show restricted diffusion on the left occipital lobe. (b) T2/FLAIR image shows ischemic signal change on the left occipital lobe and basilar artery aneurysm.
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F1
There was a small ischemic area in the left occipital lobe with abnormal diffusion restriction observed as hypointense on T1-weighted and as hyperintense on T2- weighted, FLAIR images [Figure 1a,b].
CT through the skull base reveals absence of the left carotid canal and basilar artery aneurysm.
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F2
Computed tomography angiography revealed agenesis of the left ICA and left carotid canal [Figure 2].
(a) Coronal thick-slab MIP image from a contrast-enhanced CTA shows a diminished caliber of the left CCA, terminating in the external carotid artery. The cervical left ICA is absent. The right CCA is normal in caliber. (b) DSA image shows the absence of the entire left ICA.
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F3
The caliber of the left common carotid artery (CCA) was diminished and the left CCA terminated in the external carotid artery (ECA), with complete absence of the cervical, petrous, cavernous, and supraclinoid segments of the left ICA [Figure 3a,b].
(a) DSA image shows two fusiform basilar artery aneurysms and left vertebral artery aneurysm. (b) 3D volume rendered CTA image shows the basilar artery aneurysms. (c) Coronal thick-slab MIP image from a contrastenhanced CTA shows basilar and left vertebral artery aneurysms. (d) Axial thick-slab MIP image from a contrast-enhanced CTA shows prominent PcOA continuing with left MCA.
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F4
The AICA's were normal in caliber [Figure 4a-d].
DSA image of the left ECA. Collateral circulation was not encountered between left ECA and ICA.
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F5
Collateral circulation between the left ECA and ICA was not encountered [Figure 5].
Transcranial color flow Doppler ultrasound shows increased flow velocity in left posterior cerebral artery.
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F6
Transcranial Doppler sonography showed increased flow velocity in the left posterior cerebral artery [Figure 6].