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So I'm going to show you a case of Takayasu's.

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This patient had some intermittent left-sided

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weakness and her brain diffusion-weighted

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imaging did not show an acute stroke.

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So this is just relatively normal

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diffusion-weighted imaging, but

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then she has very abnormal vessels.

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So let's take a look at the vessels.

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This is a snapshot of the neck

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vessels and this looks really weird.

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Here's the arch.

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I don't really see the left subclavian artery.

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I can see the left common carotid.

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It looks like there's some narrowing here.

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I can see the left vertebral artery

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distally, but I can't see it proximally.

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There are a lot of collateral vessels.

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And the right subclavian is irregular and

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there are areas of multifocal narrowing.

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The right vertebral artery can see it, but here

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it is cut off, a lot of collateral vessels.

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And then the right ICA, we can follow it

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down and hard to know what's going on there.

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We don't see the proximal right common

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carotid artery because it's occluded and

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there are a lot of collateral vessels.

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So I'm going to try to show you

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this a little bit more on the

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raw data, so here's the raw data.

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We'll just go from the top down.

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Here's the left ICA and the bifurcations there.

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Here's some stenosis and we

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do see the origin of left ICA.

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That doesn't look too bad.

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Let's look at the right ICA.

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You can see it.

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Follow it down and, you know, here's bifurcation

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and I can't really follow it down below that.

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That's because the common carotid artery is

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basically occluded, and there are a bunch

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of collateral vessels in here supplying it.

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We can show the same thing

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with the vertebral arteries.

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Here's the right vertebral artery, follow

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it down, and just kind of stops in there.

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Again, there are a bunch of

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collateral vessels around it.

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And the same thing with

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the left vertebral artery,

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follow it down.

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Follow it down and boom, there's no

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origin of the left vertebral artery.

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So this is classic Takayasu's where the

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proximal vessels, the proximal subclavians,

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the proximal common carotid arteries,

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the proximal vertebral arteries get

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occluded and you get collateralization so

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that the vessels are supplied distally.

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And when we look at the circle of Willis,

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There is some decreased flow related

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enhancement in the right ICA.

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The MCAs look nearly symmetric.

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The posterior circulation, vertebral basilar

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junction, basilar PCAs look fine here.

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But likely, she was having some intermittent

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left-sided weakness because she has maybe some

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mild hypoperfusion to the right side because

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she's not getting enough flow up her carotid.