case_images: PMC5794378_01
case_images: Brain diffusion-weighted magnetic resonance imaging revealed focal hyperintensities in the left insula and basal ganglia (A). Head magnetic resonance angiography showed an angiostenosis (arrow) in the initial part of the middle cerebral artery (B). MRI of the arterial walls revealed a double-lumen sign (C, arrow).
case_images: medi-97-e9695-g001.jpg
case_images: PMC5794378_01_medi-97-e9695-g001.jpg
case_images: F1
case_images: Brain diffusion-weighted magnetic resonance imaging (MRI-DWI) revealed spot-like and patchy hyperintensities in the left insula, basal ganglia, putamen, corona radiata, and centrum semiovale (Fig. 1A). The remarkable stenosis covering more than 95% of the lumen area was located in the initial part of middle cerebral artery (Fig. 1B). MRI (February 16, 2014) of the arterial walls revealed a double-lumen sign (Fig. 1C).
case_images: Brain digital subtraction angiography at admission revealed a remarkable stenosis (arrow) and a slight stenosis (arrowhead) in the left middle cerebral artery (A). Eleven days following anti-platelet treatment, the repeated brain CT showed hypodensity in the left putamen, suggestive of an old cerebral infarction (B). Repeated DSA (C) showed that the angiostenosis in the middle cerebral artery was significantly improved (arrow), and only slight stenosis remained (arrowhead).
case_images: medi-97-e9695-g002.jpg
case_images: PMC5794378_01_medi-97-e9695-g002.jpg
case_images: F2
case_images: In addition, brain digital subtraction angiography (DSA; February 17, 2014) confirmed the angiostenosis in the initial part of middle cerebral artery (Fig. 2A). Repeated brain CT showed hypodensity in the left putamen, suggestive of an old cerebral infarction (Fig. 2B). DSA showed that the angiostenosis in the middle cerebral artery was significantly improved (Fig. 2C). During a follow-up period of 2 years, the patient remained neurologically asymptomatic and led a virtually normal life.