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Askiel Bruno, MD; William T. C. Yuh, MD; José Biller, MD; Harold P. Adams, Jr, MD; Steven H. Cornell, MD

Arch Neurol. 1988;45(3):303-306.

Abstract
• The number, size, and location of cerebral infarctions, and blood flow in the middle cerebral artery as seen on proton magnetic resonance imaging were assessed in six white adults with angiographically documented moyamoya. Findings were correlated with clinical presentation, computed tomography, and angiography. Large hemispheric infarctions were found in five hemispheres, predominantly in watershed regions. Subcortical infarctions (n = 56) were found in all hemispheres. They were predominantly located in the centrum semiovale, in the distal beds of supply of the penetrating branches of the anterior and middle cerebral arteries. Infarction of the putamen was found in three hemispheres, caudate nucleus in four, globus pallidus in two, and anterior limb of the internal capsule in two. There were none in the posterior limb of the internal capsule, thalamus, brain stem, or cerebellum. Middle cerebral artery flow was visualized as a signalvoid flow sign in only three hemispheres. Cerebral infarctions due to moyamoya are bilateral, multiple, often small, and asymptomatic, affecting predominantly the carotid circulation in watershed regions. Subcortical infarctions in the centrum semiovale and large hemispheric infarctions in hemodynamically compromised areas are the predominant findings.

Author Affiliations
From the Division of Cerebrovascular Diseases, Department of Neurology (Drs Bruno, Biller, and Adams) and Department of Radiology (Drs Yuh and Cornell), University of Iowa College of Medicine and Veterans Administration Medical Center, Iowa City.

Footnotes
Accepted for publication Nov 7, 1987.

Reprint requests to Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 (Dr Bruno).

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