Moyamoya disease angiographic appearance

A 57-year-old female presented with headaches, blurry vision, and dizziness. She also reported intermittent paresthesia and weakness in her right upper and lower extremities. MR imaging of the brain (including diffusion weighted imaging) revealed no evidence of acute ischemic stroke. A cerebral catheter angiogram was performed. Anteroposterior views following a right common carotid artery (Panel A) and left common carotid artery (Panel B) contrast injection, as well as a lateral view after a right common carotid artery (Panel C) contrast injection are shown. The patient's imaging demonstrates significant bilateral supraclinoid internal carotid artery stenosis or occlusion with development of extensive extracranial-intracranial leptomeningeal collaterals near the skull base, consistent with Moyamoya disease. She subsequently underwent a successful superficial temporal artery-middle cerebral artery bypass in the symptomatic (eg, left) hemisphere with significant reduction of her symptoms. (Contributed by Dr. Matthew Reynolds.)