Magnetic resonance imaging in young adults with cerebral infarction due to moyamoya
A. Bruno, W. T. Yuh, J. Biller, H. P. Adams Jr and S. H. Cornell
Department of Neurology, University of Iowa College of Medicine, Iowa City.
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 signal-void 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.
