PMC8266195_01
Neuroimaging findings in patient 1. (A) T1-weighted and (B) T2-weighted axial cranial magnetic resonance imaging showed multiple flow-voids on both basal ganglia. (C) Magnetic resonance cerebral angiography revealed severe stenosis in the proximal circle of Willis, with numerous collateral vessels. (D)
18F-FDG PET images and (E) statistical parametric mapping analysis showed hypermetabolism in the left striatum and fronto-parietal cortex, with slight hypometabolism in the left temporal region.
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Brain magnetic resonance imaging (MRI) showed no positive evidence of acute or chronic stroke lesions and multiple flow-voids on both basal ganglia on T1- and T2-weighted images (Figures 1A,B). Magnetic resonance cerebral angiography (MRA) demonstrated severe stenosis in the proximal intracranial portion of the ICAs as well as the main branches within the circle of Willis, with numerous basal collateral arteries being involved (Figure 1C), which conformed to guidelines for diagnosing MMD.
PMC8266195_02
Neuroimaging findings of patient 2. (A)T1-weighted axial and (B) T2-weighted cranial magnetic resonance imaging showed hyperintense signal in the left basal ganglia. (C) Magnetic resonance cerebral angiography revealed severe stenosis of internal carotid arteries in the supraclinoid portion, with numerous collateral vessels. (D)
18F-FDG PET images and (E) statistical parametric mapping analysis showed hypermetabolism in right striatum and fronto-parietal regions, with diffuse hypometabolism in left brain area.
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T2-weighted images (Figures 2A,B), which was consistent with the diagnosis of intracerebral hemorrhage (ICH). MRA revealed severe stenosis of both ICAs in the supraclinoid portion, with numerous collateral vessels being involved (Figure 2C). The hemichorea movements were gradually alleviated 2 weeks from disease onset, with a full recovery of the right hemiparesis. Two months later, left STA-MCA bypass and EDAMS were performed.