Puff of smoke is a feature of: (A) Joube syndrome, (B) Moya Moya disease, (C) Both, (D) None of the above
Answer is B. Puff of smoke is a feature of Moya Moya disease on Angiography It is caused due to chronic vasospasm of supraclinoid pa of ICA. IVY'S SIGN- Prominent leptomeningeal collaterals in moya-moya disease result in vivid contrast enhancement and high signal on FLAIR due to slow flow. The appearance is reminiscent of the brain having been covered with ivy. Figure: Puff of smoke sign