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Multiple stenotic regions in the anterior circulation, mainly central vesessels (M1, A1 segments).
Enlarged perforator branches from L. MCA giving rise to small corkscrew parenchymal vessels. This appearance of puff of smoke classical of moyamoya phenomenon.
Enlarged pericallosal and anteror choroidal arteries again with collaterals.
Vertebrobasilar cirulcation (not shown) is not stenotic and is supplying collaterals to the anterior circulation well rostral to the occiptio-parietal sulcus. Similarly external carotid artery is fully patent and contributing to the anterior circulation.