A 50 year-old female with right hemiplegia and encephalopathy

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Presentation transcript:

A 50 year-old female with right hemiplegia and encephalopathy Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Moughamian, et al.

Vignette A 50 year old Japanese female with no significant past medical history presented with right hemiplegia and altered mental status Non-contrast head CT showed an intracerebral hemorrhage centered in the left thalamus CT angiography demonstrated an ICH spot sign and intracranial vasculopathy consistent with Moyamoya disease © 2013 American Academy of Neurology Moughamian, et al.

Imaging Moughamian, et al. © 2013 American Academy of Neurology CT and CT angiography (CTA) of the brain at presentation A) Axial and coronal non-contrast CT brain images show a hemorrhage centered in the left thalamus. B) Axial CT angiography shows a focal area of contrast enhancement within the hemorrhage suggestive of an ICH spot sign and coronal images demonstrate a prominent posterior thalamo-perforating artery near this spot sign (arrow). © 2013 American Academy of Neurology Moughamian, et al.

Imaging Moughamian, et al. © 2013 American Academy of Neurology Cerebral angiogram (digital subtraction angiography) Lateral (A) and A/P (B) views of the posterior circulation on cerebral angiography. The white arrowhead demarcates a distal peripheral artery aneurysm. (C, D) Magnified views show a single artery supplying bilateral thalami consistent with an artery of Percheron (black arrows) and associated aneurysm (black arrowhead). © 2013 American Academy of Neurology Moughamian, et al.

Artery of Percheron Aneurysm Masquerading as ICH Spot Sign The artery of Percheron is a rare posterior circulation vascular variant in which a single artery supplies bilateral thalami. Intracranial aneurysms may complicate Moyamoya disease and occur at the circle of Willis, distal peripheral arteries, or Moyamoya vessels at a ratio of 3:1:11. Aneurysms in thalamo-perforating arteries are rare2 and an artery of Percheron aneurysm in Moyamoya disease has not been reported previously. In Moyamoya, presence of a spot sign should prompt consideration for angiography. 1. Kawaguchi S, Sakaki T, Morimoto T, Kakizaki T, Kamada K. Characteristics of intracranial aneurysms associated with moyamoya disease. A review of 111 cases. Acta Neurochir (Wien) 1996;138:1287-1294. 2. Zhang L, Xu K, Zhang Y, Wang X, Yu J. Treatment strategies for aneurysms associated with moyamoya disease. Int J Med Sci 2015;12:234-242. © 2013 American Academy of Neurology Moughamian, et al.