case_images: PMC9950533_01
case_images: A-B, MRI-DWI shows bilateral white matter hyperintensities at centrum semiovale and high convexity level affecting the ACA-MCA watershed territories (red arrows). C, T1 postcontrast MRI showed leptomeningeal enhancement along the right cortical sulci compatible with an "ivy sign" (blue arrow).. DWI: diffusion-weighted imaging, ACA: anterior cerebral artery, MCA: middle cerebral artery
case_images: cureus-0015-00000034172-i01.jpg
case_images: PMC9950533_01_cureus-0015-00000034172-i01.jpg
case_images: FIG1
case_images: Magnetic resonance imaging (MRI) of the brain showed bilateral hyperintensities in the anterior cerebral artery (ACA)-middle cerebral artery (MCA) border zone territories consistent with a bilateral watershed ischemic stroke (Figure 1A, 1B). T1 postcontrast MRI showed right leptomeningeal enhancement resembling an "ivy sign" (Figure 1C).
case_images: Lateral view right ICA angiogram shows occlusion at the supraclinoid segment of the ICA (A, red arrow), anastomosis of the ophthalmic artery with the posterior ethmoidal artery (A, red arrowhead), and dural anastomosis (A, blue arrows). Lateral view left ICA angiogram shows occlusion at the supraclinoid segment of the ICA (B, red arrow), anastomosis with the temporal artery (B, red arrowhead), middle meningeal artery (B, blue arrowhead), and dural anastomosis (B, blue arrows). Anterior view of left vertebral artery angiogram shows multiple anastomoses (C, blue arrows) and well-developed posterior cerebral arteries which supply the ACA and MCA territories (D).. ICA: internal carotid artery, ACA: anterior cerebral artery, MCA: middle cerebral artery
case_images: cureus-0015-00000034172-i02.jpg
case_images: PMC9950533_01_cureus-0015-00000034172-i02.jpg
case_images: FIG2
case_images: The angiogram of the vertebral arteries showed narrowing of the basilar artery, a well-developed posterior cerebral artery (PCA) supplying the vascular territories of the MCA and ACA, and multiple anastomoses (Figure 2).