Wednesday, May 13, 2009

Puff of Smoke

A 45 year old Japanese woman with atherosclerosis and Graves' disease presents with recurrent hemorrhagic stroke. She has no known risk factors: no hypertension, no alcohol, no dyslipidemia, and no trauma. CT shows dilatation of sulci and focal ventricular enlargement suggesting chronic disease. MRI shows dilated collateral vessels in the basal ganglia and thalamus. Angiography is shown above.

Challenge: This is a "double name." What is the cause of the hemorrhagic strokes?

Image shown under fair use.


tree said...


Alex said...

haha nice.. i thought "repeat week" would be funny cuz they're not real repeats.

Stephanie said...

moyamoya! :)

Craig Chen said...

Yes! Another favorite Moffitt diagnosis. Alex's last idea was loaloa but I don't know anything about that disease :P.
Puff of Smoke

Moyamoya disease is a chronic progressive cerebrovascular disease characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis with prominent arterial collateral circulation. The name comes from Japanese meaning puffy, obscure, or hazy, describing the smoky angiographic appearance of the vascular collateral network. Etiology is unknown. There are many associated medical conditions; there is a female predominance, often family history, with bimodal age distribution (10-14, 45-49).

Sources: UpToDate; American Journal of Roetgenology.