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The patient is a 38-year old female with recurrent episodes of left-sided weakness. Diffusion weighted MRI (a) revealed watershed distribution right hemisphere ischemic lesions.
(a)
Quantitative dynamic perfusion CT (b) demonstrated diminished right MCA territory cerebral perfusion, and MRA (c) demonstrated a focal right MCA stenosis.
(b)
(c)
This was confirmed angiographically (d), and the lesion responded to intracranial angioplasty and stenting {see post stent image (e)}. The patient experienced a dramatic resolution of left-side weakness, and TIAs ceased immediately.
(d)
(e)