Fig 2.

A 15-month-old girl (diagnostic age group younger than 4 years of age) initially presented with CS with right upper motor paresis a month before and subsequently presented with contralateral hemiparesis CS. Moyamoya disease was diagnosed. Her clinical manifestation was CS. A and B, Coronal and axial time-of-flight MR angiograms show steno-occlusive bilateral lesions in the terminal part of the ICA and in the proximal parts of the ACA and MCA cerebral arteries (ICA stage II, bilaterally). The right PCA is almost completely occluded (short arrow), with well-developed dilated perforators around it (stage III); the proximal part of the left PCA is stenotic (long arrow, PCA stage II). Note that in this patient, the bilateral steno-occlusive changes involved the PCAs even in the hemispheres with less advanced ICA lesions (ICA stage II, bilaterally). C, Diffusion-weighted MR image shows hyperintense regions of recent infarction in the anterior and posterior watersheds and the boundary zone between the regions of the ACA and PCA in the right. Five infarcted zones are seen on the right. D, T2-weighted MR image additionally shows an old cortical infarction in the posterior MCA territory (arrow), seen on the left.