PMC5760678_01
Axial brain MRI of the patient in FLAIR (A) and T2-sequence (B) illustrating involvement of right deep white matter
ijcn-12-089-g001.jpg
PMC5760678_01_ijcn-12-089-g001.jpg
F1
According to the previous history of her upper respiratory tract infection (URTI), the course of onset the symptoms and brain MRI which showed right deep white matter lesions, it was not in accordance with the known vascular territories (Fig. 1).
Second brain MRI. A. Axial plane, FLAIR sequence B. Sagital plane, T2-sequence and C. Axial plane, T2-sequenceshowing more developing lesions which seems have a vascular pattern (arrow
ijcn-12-089-g002.jpg
PMC5760678_01_ijcn-12-089-g002.jpg
F2
A repeated brain MRI revealed further lesions fitting more on the arterial territories at this time, rather than purely white matter involvement (Fig. 2).
Brain and cervical CT-Angiography. A-Note bilateral narrowed internal carotids (arrows). B-collateral vascular networks appear "puff of smoke" pattern
ijcn-12-089-g003.jpg
PMC5760678_01_ijcn-12-089-g003.jpg
F3
CT angiography was done. CT angiography showed bilateral internal carotid stenosis with "puff of smoke" collateralization arising from the circle of Willis, therefore a diagnosis of Moyamoya disease was raised (Fig. 3).