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Walk the Even Hospital Database by book and chapter — the raw source passages that ground Ask, DDx, and the rest.
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©2013 UpToDate ® Print Email 30 year old man with presumed moyamoya disease A) FLAIR images show increased linear signal in the sulci (white arrow) due to retrograde slow flow in engorged pial arteries via leptomeningeal anastomoses*. B) Right internal carotid artery injection from a conventional angiogram, lateral projection, confirms no flow in the proximal right middle and anterior cerebral arteries with "puff of smoke" appearance of collateral vessels (black arrow). C) CTA shows almost no flow in the supraclinoid internal carotid arteries and the proximal middle and anterior cerebral arteries. White arrows indicate multiple surrounding collaterals around the proximal middle cerebral arteries. * Maeda M, Yagishita A, Yamamoto T et al. Abnormal hyperintensity within the subarachnoid space evaluated by fluid-attenuated inversion-recovery MR imaging: a spectrum of central nervous system diseases, Eur Radiol (2003) 13:L192-L201. Courtesy of Eric D Schwartz, MD.