case_images: PMC10559387_01
case_images: (a and b) Magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) demonstrating an infarct involving the left basal ganglia, insula, and opercular region. (c and d) MRI fluid-attenuated inversion recovery showing an infarct compatible with that of DWI. (e and f) Magnetic resonance angiography reveals no flow signal intensity in the left neck internal carotid artery (ICA) and contrast computed tomography demonstrates occlusion of the left neck ICA.
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case_images: F1
case_images: Magnetic resonance imaging (MRI) and computed tomography (CT) angiography showed occlusion of the proximal left cervical carotid artery and ipsilateral ischemic stroke [Figures 1a-f].
case_images: (a and b) Cerebral angiography demonstrating collateral flow to the left hemisphere through the anterior communicating artery and leptomeningeal anastomoses from the posterior cerebral artery. (c) Left external carotid artery angiography showing opacification of the internal carotid artery and ophthalmic artery through the middle meningeal artery. (d-f) 123I-iodoamphetamine single- photon emission computed tomography demonstrating cerebral blood flow reduction at rest and cerebral vascular reserve in response to acetazolamide in the left hemisphere.
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case_images: F2
case_images: Cerebral angiography was performed to examine the cerebral blood flow in the left hemisphere [Figures 2ac]. Thereafter, hemodynamic impairment was assessed using 123I-iodoamphetamine single-photon emission CT (123I-IMP SPECT), and the results showed a reduced cerebral blood flow at rest and cerebral vascular reserve in response to acetazolamide in the left hemisphere [Figures 2d-f].
case_images: (a and b) Intracranial magnetic resonance angiography (MRA) showing patency of the donor artery following a day and 7 days after superficial temporal artery-middle cerebral artery bypass, respectively. (c and d) Magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) revealed no new infarction on postoperative day 7. (e) 123I-iodoamphetamine single-photon emission computed tomography showed no apparent region of hyperperfusion on postoperative day 9. (f-h) Immediate MRI after secondary generalized seizure demonstrated no new infarction on DWI and MRA revealing diminishing signal intensity of the donor artery.
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case_images: F3
case_images: A day and 7 days after the surgery, magnetic resonance angiography (MRA) showed good patency of the donor artery [Figures 3a and b], and the patient had an absence of new lesions or neurological deficits [Figures 3c and d]. Rest 123I-IMP SPECT showed no region of hyperperfusion 9 days after the operation [Figure 3e]. Furthermore, MRA revealed a diminished signal intensity of the donor artery [Figures 3f-h].
case_images: (a and b) Evaluation of the blood flow of the donor artery using ultrasonography which revealed a prominent decrease in blood flow during mouth opening. (c) Computed tomography angiography confirms good patency of the donor artery after the event.
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case_images: F4
case_images: Opening of the mouth caused a 32% reduction in the peak systolic velocity than that of mouth closing, which showed good donor artery patency on CT angiography [Figures 4a-c].