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Hi I'm dr andrew dixon from Radiopaedia.org and in this video we are going to look at the
'puff of smoke sign' which is an angiographic feature of moya moya disease.
here are lateral images from a vertebral artery injection and we can see that
emanating away from the basilar there is a fine irregular network of curly
vessels simulating the appearance of smoke.
on these AP angiographic images from an internal carotid artery injection we can
better appreciate the primary abnormality in moya moya disease
severe narrowing off the circle of Willis vessels. It is this narrowing that
results in the development of the collaterals perforating through the
basil ganglia to supply blood to the rest of the brain.
These corresponding MR angiogram images demonstrate nicely how these
vessels perforate into the brain substance.
so a pretty cool little sign that one the puff of smoke sign in moya moya
disease. You can find out more on the Radiopaedia.org website.