Moyamoya Syndrome Presenting as Migraine-Like Headache: MRI, MRA, DSA Imaging Clues and the Clinical Significance of Cerebrovascular Reserve
Subtitle A radiologist’s approach to a 47-year-old man with recurrent headache, photophobia, phonophobia, and nausea, with emphasis on abnormal collateral vessels, severe proximal M1 stenosis, multimodal neurovascular imaging, differential diagnosis, revascularization, and the emerging role of AI. Executive Clinical Summary A 47-year-old man presented with recurrent headaches accompanied by photophobia, phonophobia, and nausea. Each episode lasted approximately 2–3 hours and occurred about four times per month. Neurologic examination did not reveal a definite abnormality. Clinically, the presentation could easily be interpreted as migraine. The imaging findings, however, changed the diagnostic perspective. Brain MRI demonstrated multiple abnormal vascular flow-void structures along the left Sylvian fissure. TOF-MRA demonstrated severe stenosis of the proximal left M1 segment with reduced visualization of the distal MCA branches. The combination of major intracranial arteri...