Neuro-Ophthalmic Vascular Disease

A 9-year-old boy had recurrent ischemic episodes that had begun 2 years prior to evaluation. A significant right hemiparesis and a significant speech, learning, and memory disorder were present. His noncontrast axial view CT scan demonstrated multiple cerebral infarcts. Cerebral angiography revealed findings diagnostic of moyamoya disease. The lateral view right common carotid subtraction angiogram demonstrated occlusion of the supraclinoid carotid, with massive dilatation of the medullary arteries. Similarly, the lateral view vertebral subtraction angiogram showed occlusive disease involving the posterior cerebral arteries, with a large area of dilatation of the proximal perforating branches and chorodial arteries. Pair with Images 93_21 and 93_23.