Moyamoya with leptomeningeal "ivy" sign

Case contributed by Dr Amro Omar

Presentation

Transient ischemic attacks , headache

Patient Data

Age: 13
Gender: Female
MRI

2011

FLAIR shows bright sulci or leptomeningeal "ivy" sig , which denoted slow-flowing engorged pial vessels, thickened arachnoid membranes

MRI

2013

  • FLAIR shows bright sulci or  leptomeningeal "ivy" sign, which denoted slow-flowing engorged pial vessels, thickened arachnoid membranes
  • T1WI C + shows leptomeningeal enhancement (contrast-enhanced "ivy" sign)
  • MRA: Narrowed distal ICA and proximal COW vessels , corresponds to puff of smoke in conventional angiography

Case Discussion

The ivy sign refers to the MRI appearance of patients with moya moya disease or moya moya syndrome. Prominent leptomeningeal collaterals result in vivid contrast enhancement and high signal on FLAIR due to slow flow. 

Ivy sign differential diagnosis :

  • leptomeningeal metastases
  • subarachnoid hemorrhage (SAH)
  • meningitis
  • increased inspired oxygen
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Case information

rID: 32468
Case created: 27th Nov 2014
Last edited: 26th Jun 2017
Inclusion in quiz mode: Included

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