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FIG 4. 35-year-old man who initially presented with right hemiparesis and speech disturbance at 3 years of age. Moyamoya disease was diagnosed at the same age on the basis of cerebral angiographic findings.
A, Lateral view of a left carotid angiogram shows complete occlusion of the ICA just distal to the origin of the ophthalmic artery (ICA stage VI). The ophthalmic artery is enlarged and provides collateral circulation mainly to the ACA distribution. The basal perforators are slightly dilated. A right carotid angiogram also showed ICA stage VI (not shown).
B, Lateral view of right vertebral angiogram discloses severe stenoocclusive changes of bilateral PCAs with no opacification of cortical branches (PCA stage 4).
C and D, Axial T2-weighted (3000/100/1) MR images reveal infarctions in the AWS, ant-MCA, post-MCA, PWS, and PCA territories on both sides.
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