MRI - Cerebral MRA
Complete segmental occlusion of both middle cerebral arteries and left anterior cerebral artery.
Markedly narrowed terminal segments of both internal carotid arteries.
Extensive collateral vessel formation along the paths of both middle cerebral arteries, with tortuous lenticulostriate collaterals (puff of smoke), bilaterally. A collateral arterial network is also formed medially within both parietal lobes and cingulate gyri, more pronounced on the left side.
No intracranial aneurysm.