PMC6788746_01
Head CT on initial presentation (day 1), axial section and coronal reformat, showing bilateral basal ganglia hemorrhages.
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F1
Head computed tomography (CT) on presentation (day 1) revealed bilateral basal ganglia hemorrhages (Fig 1).
Sequential head MRA showing evolution of multifocal vascular stenoses. Relatively normal MCAs (arrows) and anterior cerebral arteries (ACAs) (arrowheads) on day 10 are shown in A. Both ACAs and MCAs were severely constricted on day 21 (B). On day 26, there was near resolution of the diffuse intracerebral vasculature constriction (C).
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F2
Cerebral MR angiography (MRA) on day 10 showed relatively normal middle cerebral arteries (MCAs) and anterior cerebral arteries (ACAs) (Fig 2A), and MRI at that time showed no evidence of infarction (not shown). Repeated MRA on day 21 revealed evolving vascular abnormalities, with both ACAs and MCAs having become severely constricted (Fig 2B). Near resolution of the diffuse intracerebral vasculature constriction on MRA was demonstrated on day 26 (Fig 2C).
Conventional cerebral angiography on day 11, right internal artery injection, lateral projection, showing multifocal arterial vasoconstriction (arrows show three examples, but a diffuse process is demonstrated).
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F3
However, conventional cerebral angiography on day 11 revealed subtle and multifocal arterial vasoconstriction (Fig 3).
Head MRI on day 14, diffusion-weighted imaging, showing scattered regions of reduced diffusivity, representing small infarctions (arrows) in the territory of the left middle cerebral artery. On the right panel, basal ganglia hemorrhages are also demonstrated.
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F4
Subsequent brain magnetic resonance (MR) imaging on day 14 showed small left MCA infarctions (Fig 4).