PMC3589846_01
Magnetic resonance (MR) image. (a) MRI T2-weighted image shows no ischemic lesion. The flow-void signal of the right middle cerebral artery is sluggish, (b) MRA shows steno-occlusive at the terminal portion of the right internal carotid artery
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However, flow-void sign of the right middle cerebral artery was sluggish [Figure 1].
Cerebral angiography. (a) Right cerebral angiography reveals severe stenosis at the terminal portion of the internal carotid artery with development of moyamoya vessels, (b) Left carotid angiography shows no apparent abnormality, (c) Left vertebral angiography shows no apparent abnormality. The leptominingeal anastomosis is developed in the right side
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Right carotid angiogram demonstrated stenosis of the terminal portion of the ICA with moyamoya vessels [Figure 2a]. Left carotid angiogram and left vertebral angiogram showed no apparent abnormality [Figure 2b and c].
Single photon emission tomography. (a) Right hypoperfusion was detected, (b) Response to the acetazolamide was impaired in the right side
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The response to the acetazolamide was impaired [Figure 3].
MR angiography 7 years after the onset. (a) MIP image shows no significant change, (b) Source image revealed cerebral aneurysm
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However, 7 years after the diagnosis, cerebral aneurysm appeared in the right basal cistern, probably from anterior choroidal artery, and conventional angiography was planed [Figure 4].
Computed tomography (CT). (a) CT shows massive intraventricular hemorrhage, (b) CT with contrast medium revealed enlargement of the cerebral aneurysm, (c) CT angiography showed cerebral aneurysm arising from right anterior choroidal artery, (d) CT angiography coronal image showed cerebral aneurysm (arrow) arising from right anterior choroidal artery (arrow head)
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Computed tomography (CT) showed massive intraventricular hemorrhage [Figure 5a]. Enlargement of the aneurysm was revealed by CT angiography [Figure 5b-5d].