Medullary streaks in a patient with atherosclerotic internal carotid artery occlusion: case report

BACKGROUND: Magnetic resonance imaging (MRI) of a patient with atherosclerotic internal carotid artery (ICA) occlusion demonstrated medullary streaks in the deep white matter, which were previously observed only in moyamoya disease and may indicate decreased cerebral blood flow. Cerebral perfusion and metabolism were evaluated using positron emission tomography (PET). CASE DESCRIPTION: A 46-year-old man presented with right hemiparesis and motor aphasia. Cerebral angiography showed left cervical ICA occlusion. MRI showed medullary streaks in the deep white matter of the left middle cerebral artery (MCA) territory. PET imaging of this region revealed decreased cerebral blood flow and increased oxygen extraction fraction and cerebral blood volume. MRI after superficial temporal artery-MCA anastomosis revealed decreased intensity of the medullary streaks. CONCLUSIONS: Medullary streaks in patients with atherosclerotic ICA occlusion may indicate reduced perfusion pressure and increased risk of recurrent stroke.