PMC7098361_01
MRI performed at the beginning of the first hospital admission showing bilateral hemispheric infarction (a) in DWI and a time of flight imaging (b) revealing bilateral ICA-stenosis including the right C3-C5 segments and the left C3-C4 segments (see arrows, classification according to Bouthillier 1996).
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F1
CT-angiography and MRI/MR-angiography revealed stenosis of both intracranial ICA pronounced on the right side (Fig. 1), a perfusion deficit of the right hemisphere, and bilateral new infarcts also pronounced on the right side.
MRI performed 4 months after the initial hospital admission showing a new ICA occlusion on the right side and an ICA stenosis on the left side nearly identical to the previous imaging (see arrows, C3-C4 segments).
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F2
Although during that next hospital stay the patient did not complain of any new symptoms, MRI showed new infarcts on the right side and an occlusion of the right ICA (Fig. 2).
Duplex sonography (a), PW-Doppler image (b), and MRI time of flight imaging (c) of the left sided extra-intracranial bypass.
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F3
Nine months after the first hospital admission and still under corticoid treatment, an MR-angiography ("black-blood imaging sequence") revealed left-sided ICA vessel wall enhancement of the cavernous and petrosal segments (Fig. 3) which can be considered a proof of CGA in that context.