PMC10400005_01
Time-of-flight MR angiographies of patient 1. Initial examination (A) shows multiple stenoses (arrowheads) involving P3 segment of right and left posterior cerebral artery, and M3 and M4 segments of left middle cerebral artery. Control MRA at 5 months (B) shows a complete resolution of these stenoses.
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F1
Brain MRI confirmed the absence of brain lesions but the presence of several bilateral arterial irregularities on MR angiography (3D time of flight) (Figure 1).
PMC10400005_02
Initial brain MRI of patient 2 (A, B) shows multiple bilateral confluent hyperintense lesions involving the subcortical white matter and diffuse cerebral edema (FLAIR sequence, axial view). MRI after clinical worsening (a week later) (C): extension of FLAIR hyper-intensities in parietal and frontal lobes associated with gadolinium enhancement (D).
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F2
MRI revealed an extension of FLAIR and DWI hyper-intensities in the occipital and parietal lobes and the cerebellum with cortical laminar necrosis of the left precentral gyrus and occipital lobes (Figure 2).
Digital subtraction angiography in patient 2 (A) performed 2 days after admission shows narrowing of proximal segments involving middle (M1) and anterior (A1) arteries. 3D time of flight angiography in the same patient a day after (B) shows stenoses of anterior cerebral artery (A2-A3). A week later control (C) shows proximal stenosis of left posterior cerebral artery. Resolution of cerebral artery stenoses at 6-month control (D).
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F3
Doppler ultrasonography showed multiple focal increased velocities on brain arteries. Digital subtraction angiography showed narrowing of proximal segments involving middle, anterior, and posterior cerebral arteries (Figure 3).