Presentation
Transient ischemic attacks, headache
Patient Data
Age: 13 years
Gender: Female
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FLAIR sequence shows bright sulci or leptomeningeal "ivy" sign, which may be caused by slow-flowing engorged pial vessels, thickened arachnoid membranes
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- FLAIR: bright sulci or leptomeningeal "ivy" sign. Given the post-contrast and angiographic findings, this represents slow-flowing engorged pial vessels, thickened arachnoid membranes
- T1WI C+: leptomeningeal enhancement (contrast-enhanced "ivy" sign)
- MRA: narrowed distal internal carotid artery and proximal circle of Willis vessels, which would correspond to a "puff of smoke" appearance on conventional angiography
Case Discussion
The ivy sign refers to the MRI appearance of patients with moya moya disease or moya moya syndrome. Prominent leptomeningeal collaterals result in vivid contrast enhancement and high signal on FLAIR due to slow flow.
Ivy sign differential diagnosis:
- leptomeningeal metastases
- subarachnoid hemorrhage
- meningitis
- increased inspired oxygen