8-year-old girl with a history of sickle cell disease and left MCA stroke. Evaluate for stenosis and moyamoya. MRI brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. Again seen is volume loss and T2 hyperintensity indicating encephalomalacia in the left MCA territory including the left temporal and to a lesser degree left parietal lobe. Additional foci of T2 hyperintensity in the left frontal lobe white matter are unchanged. The right inferior frontal gyrus developmental venous anomaly is redemonstrated. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA brain: Evaluation is somewhat limited due to motion artifact. There is narrowing in the bilateral supraclinoid internal carotid arteries and diminished flow focally in the proximal right M1 segment. There is also diminished flow at the left MCA bifurcation which appears more severe when compared to prior however there is artifact at this location. There is reconstitution of flow in the more distal MCA branches bilaterally. The bilateral A1 segments are narrowed but reconstituted distally. These findings are overall similar to the prior study as is the appearance of prominent lenticulostriate collaterals vessels allowing for differences in technique and artifacts. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. No aneurysm is identified.
1.Stable findings of encephalomalacia related to prior left MCA infarct. No new or acute infarct.2.Allowing for differences in technique there is no significant interval change in stenosis in the supraclinoid ICAs, bilateral M1 and A1 segments. The mildly prominent lenticulostriate collaterals also appears similar. These findings are again compatible with moyamoya pattern.