PMC5364927_01
A diffusion-weighted magnetic resonance imaging on admission (a, b) confirmed an infarction in the left temporal and parietal lobe. 
123
I-IMP single-photon emission computed tomography (c) revealed severely decreased cerebral blood flow in the left middle and posterior cerebral artery territory.
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The magnetic resonance imaging (MRI) performed at the patient's admission confirmed an infarction in the left temporal and parietal lobe (Fig. 1a, b). Digital subtraction angiography (DSA) confirmed the diagnosis of moyamoya disease (Fig. 2). 123I-IMP single-photon emission computed tomography (SPECT) revealed that the cerebral blood flow (CBF) was severely decreased particularly in the left middle and posterior cerebral artery territory (Fig. 1c).
Anterior-posterior views of the left (a) and right (b) internal carotid arteriography, and the lateral view of the left internal carotid arteriography (c) show that they were occluded at the supraclinoid portion, and the anterior and middle cerebral arteries are reconstituted by collaterals from ophthalmic artery and pial collaterals along the convexity of the brain. Left external carotid arteriography (d) shows that the frontal branch of the superficial temporal artery (arrowhead) has collateral blood supply to the middle cerebral artery territory.
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Digital subtraction angiography (DSA) confirmed the diagnosis of moyamoya disease (Fig. 2). 123I-IMP single-photon emission computed tomography (SPECT) revealed that the cerebral blood flow (CBF) was severely decreased particularly in the left middle and posterior cerebral artery territory (Fig. 1c).
Left-anterior oblique view of postoperative magnetic resonance angiography (a), the left occipital arteriography (b) and the external carotid arteriography (c) taken 6 months after the operation. The neovascularization (asterisks) developed well especially from the meningeal arteries. However, the anastomosed arteries, the branch of the occipital artery (arrows), and the parietal branch of the superficial temporal artery (arrowhead), decreased in caliber and their anastomosed sites could not be detected.
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