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Radiological Reasoning: Extracranial Causes of Unilateral Decreased Brain Perfusion

Benjamin Y. Huang1 and Mauricio Castillo

1 Both authors: Department of Radiology, University of North Carolina at Chapel Hill, CB #7510, 101 Manning Drive, Chapel Hill, NC 27599-7510.


Figure 1
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  		Fig. 1A —50-year-old man with neurologic symptoms and upper extremity claudication associated with exercise. Image from perfusion MRI time-to-peak (TTP) map shows delayed TTP in most of right cerebral hemisphere (arrows).

 

Figure 2
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  		Fig. 1B —50-year-old man with neurologic symptoms and upper extremity claudication associated with exercise. Maximum-intensity-projection (MIP) image from 3D time-of-flight (TOF) MR angiography (MRA) of circle of Willis shows diminished flow-related signal in right internal carotid artery (ICA) (arrows) and right middle cerebral artery (arrowheads).

 

Figure 3
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  		Fig. 1C —50-year-old man with neurologic symptoms and upper extremity claudication associated with exercise. MIP image from subtracted 3D gadolinium-enhanced MRA of neck shows complete occlusion of innominate (brachiocephalic) artery just distal to its origin (arrowheads). Right ICA, right subclavian artery, and right vertebral artery are patent, but right ICA is small relative to left.

 

Figure 4
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  		Fig. 1D —50-year-old man with neurologic symptoms and upper extremity claudication associated with exercise. MIP image from unenhanced 2D TOF neck MRA with presaturation pulses localized cephalad to acquisition volume shows no flow-related signal in right vertebral artery. Right ICA and external carotid artery are also diminutive and show decreased signal.

 

Figure 5
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  		Fig. 1E —50-year-old man with neurologic symptoms and upper extremity claudication associated with exercise. Axial source image from 2D TOF MRA again shows no flow-related signal in right vertebral artery (arrow).

 

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