title: Hyperintense ipsilateral cortical sulci on FLAIR imaging in carotid stenosis: ivy sign equivalent from enlarged leptomeningeal collaterals.
abstract: Fluid-attenuated inversion recovery (FLAIR) imaging provides high contrast between hyperintense lesions and normal tissue. Hyperintense structures in convexity sulci are commonly linked to abnormal cerebrospinal fluid composition, whether blood, protein, or infection. A patient with hemispheric transient ischemic attacks from severe carotid stenosis had hyperintense convexity sulci on FLAIR magnetic resonance imaging, interpreted as possible prior hemorrhage, making the patient ineligible for carotid stent reconstruction. Retrospective analysis revealed that hyperintense sulci were dilated leptomeningeal collaterals. In severe arterial disease causing cerebral hypoperfusion, dilated leptomeningeal vessels should be considered a cause for serpiginous hyperintense structures on FLAIR imaging, similar to the "ivy sign" described in moya-moya patients.
authors: Radiological Associates of Sacramento Medical Group Inc., 1500 Expo Parkway, Sacramento, CA, 95815, USA. Electronic address: lhaceinbey@yahoo.com.
authors: Lotfi
authors: L
authors: Hacein-Bey
authors: Radiological Associates of Sacramento Medical Group Inc., 1500 Expo Parkway, Sacramento, CA, 95815, USA.
authors: Govind
authors: G
authors: Mukundan
authors: Neurosurgical Associates, 2 Medical Plaza Drive, Suite 255, Roseville, CA 95661.
authors: Kavian
authors: K
authors: Shahi
authors: Internal Medicine, Mercy Medical Group, 4001J Street, Sacramento, CA 95819.
authors: Hung
authors: H
authors: Chan
authors: Vascular Surgery, Mercy General Hospital, 3941J Street, Suite 370, Sacramento, CA 95819.
authors: Ali T
authors: AT
authors: Tajlil
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008578:Meninges / Q000473:pathology*; D009072:Moyamoya Disease / Q000473:pathology; D059906:Neuroimaging / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media
keywords: Carotid artery; Collaterals; FLAIR imaging; Ivy sign; Leptomeningeal