Presentation
Left sided weakness.
Patient Data
There is concentric thickening of walls of bilateral ICA with relatively narrow right ICA lumen. Right ICA lumen in cavernous sinus is relatively small.
Bilateral MCA and ACA are markedly thin. Numerous thin collateral vessels are seen in the region of circle of Willis (MCA & ACA territories). Blush pattern is seen.
No vessel wall thickening or enhancement is seen in both vertebral, basilar and bilateral posterior cerebral arteries.
Subacute stage infarcts with gyriform enhancement is seen in right temporo-parieto-occipital lobes.
Case Discussion
MRI is specific in demonstrating multiple infarctions, which are typically bilateral, affecting different vascular territories, are of variable size, and are in various stages of healing. MR vessel wall imaging also known as black/dark blood sequence is showing concentric and homogeneous enhancement of bilateral ICA wall with delineation of narrowing of right ICA lumen. This sequence is important in distinguishing between various causes of luminal stenosis such as intracranial atherosclerotic disease versus vasculitis.
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