PMC4533379_01
A-D: Temporal profile of MR angiography (A-C) and MR imaging at the onset of stroke (D). A: The initial MR angiography 4 years prior to pregnancy, demonstrating moderate stenosis at the right MCA (arrow in A). B: MR angiography before delivery, demonstrating no interval change. C, D: MR angiography demonstrating apparent progression of the steno-occlusive change at the right proximal MCA three days after the delivery, (C), when diffusion-weighted MR imaging found cerebral infraction in the right hemisphere (D). E-G: Antero-posterior (E) and lateral (F) views of the right internal carotid angiogram demonstrating nearly complete occlusion of the right terminal ICA and the development of an abnormal vascular network at the base of the brain. Postoperative MR angiography revealed the apparently patent STA-MCA bypass as a thick high signal (arrow in G). ICA: internal carotid artery, MR: magnetic resonance, STA-MCA: superficial temporal artery-middle cerebral artery.
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F1
She had been found to have moderate stenosis of right MCA 4 years prior to her pregnancy (arrow in Fig. 1A). At the age of 38, she came to our gynecological and neurosurgical department because of primigravida, when MR angiography demonstrated consistent stenosis at the right initial angio-architecture of moderate MCA (M1) portion (arrow in Fig. 1B). MR angiography demonstrated apparent progression of the steno-occlusive change at the right proximal MCA (Fig. 1C), and MR imaging found cerebral infraction at right hemisphere (Fig. 1D). Catheter angiography confirmed nearly occluded right proximal MCA as well as right terminal ICA stenosis with the development of the abnormal vascular network at the base of the brain, indicating a definitive diagnosis of moyamoya disease with unilateral involvement (Fig. 1E, F). Postoperative MR angiography showed the apparently patent STA-MCA bypass as a thick high signal (arrow in Fig. 1G).