Moyamoya Disease

There are multifocal areas of acute ischemia involving several vascular distributions, most evident in the left greater than right anterior cerebral arterial distribution, as well as in the right middle cerebral artery territory. On time of flight MRA, we see high grade stenosis or occlusion of the carotid terminus on both sides with reconstitution of flow in the more distal vessels via collateralization. This patient had an established diagnosis of moya moya disease, and this case represents a typical imaging presentation of the underlying vasculopathy and ischemic complications.