Epileptic patient with recurrent attacks of ischemic strokes proved by CT.
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Occluded terminal right ICA supraclinoid part , occluded left ICA/MCA, with diffuse bilateral net of enhancing small vessels denoting collaterals. Meningeal hyperintensity in FLAIR sequences and T1W post contrast in both parietal and left temporal regions giving the ivy sign.
Right frontal lacunar infarction, left cerebral hemisphere atrophic changes.
Moyamoya disease is a vascular occlusive disease, with the development of parenchymal, meningeal and transdural collaterals. This results in ischemic changes, including infarction and brain atrophy.