Presentation
Recurrent stroke, evaluation for new lesions
Patient Data
MRI reveals old right MCA infarct with gliotic changes and minimal ex-vacuo dilatation of ipsilateral ventricle. Chronic infarcts are also noted in both basal ganglia. No new abnormal diffusion restriction foci noted.
MRA neck and brain reveals narrowing at the level of the aortic arch with involvement of major arch branches, with relative sparing of right brachiocephalic artery. Only the right CCA is visualized with the rest of the neck vessels not seen. Right distal vertebral artery is collateralized and shows good flow. Right ECA and ICA are not clearly made out, collateralization noted at that level. Right ICA is supplied via collaterals. Left ICA shows only retrograde filling.
MRA of brain vessels reveals narrowing and non-visualization of both MCAs. Almost no flow seen in both M1 and M2 segments.
Case Discussion
A patient with history of old stroke was evaluated for any new cerebral ischemic disease. She was diagnosed with type I Takayasu arteritis with associated cerebral ischemia.
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