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A tortuous network of signal voids is seen along the expected paths of both middle cerebral arteries. The bulk of both middle cerebral arteries is not identified, with absence of the expected normal luminal signal void.
Tortuous lenticulostriate collaterals are seen bilaterally, more pronounced around the left lentiform nucleus.
On the coronal images, there is evidence of grossly reduced luminal diameters of the supraclinoid and terminal segments of both internal carotid arteries.
On axial FLAIR, a diffusely hyperintense gyriform signal is seen particularly in both superior frontal lobes, secondary to prominent leptomeningeal collateral vessels (ivy sign).
No acute ischemia or intracranial hemorrhage.
No significant white matter disease.