PMC8060448_01
Imaging features. Upper panel: MRI and CT scan at admission. (A,B,D,E): Cube T1 FatSat post Gadolinium contrast, axial (A,D), coronal (B), and sagittal (E) views. (C): Contrast-enhanced CT with arterial phase, coronal view. Vasculitis of the Circle of Willis: stenosis of the left internal carotid artery, middle cerebral artery, and anterior cerebral artery (A-C), with vessel wall enhancement (A,B). Right acoustic-facial neuritis (D, arrow), sphenoid sinusitis with adjacent osteitis (E, arrow). Medium panel: MRI after sudden right hemiplegia and aphasia. (F,G) Cube T1 FatSat post Gadolinium contrast, axial view; (H) 3D Time-of-Flight angio-MR coronal view; (I) DWI sequence, axial view; (J) Arterial Spin Labeling perfusion sequence, axial view. Recent arterial ischemic stroke in the left middle cerebral territory (I) with extended hypoperfusion (J), worsening of severe and bilateral vasculitis (F-H), and left ophthalmic vein thrombosis (F, arrow). Lower panel: CT scan at day 14. (K): post-contrast axial view; (L,M) angio-CT coronal view; (N,O): axial view. Worsening of the intracranial vasculitis (K-M), with basilar artery involvement (M). Large bilateral infarcts in anterior and middle cerebral artery territories (N,O).
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F1
Brain MRI revealed vasculitis of the Circle of Willis, with vessel wall enhancement and stenosis of the left internal carotid artery, middle cerebral artery (MCA), and anterior cerebral artery, associated with sphenoid sinusitis (Figure 1). MRI confirmed recent arterial ischemic stroke in the left MCA territory, severe and bilateral vasculitis, and left ophthalmic vein thrombosis (Figure 1).