The 'puff of smoke' appearance on cerebral digital subtraction angiography, produced by a hazy network of dilated lenticulostriate and leptomeningeal collateral vessels, is characteristic of:

• A Moyamoya disease ✓
• B Giant cell arteritis
• C Fibromuscular dysplasia
• D Carotid cavernous fistula

Explanation

Moyamoya disease causes progressive stenosis of the distal internal carotid arteries and proximal anterior and middle cerebral arteries, prompting formation of fragile deep collateral channels that give the angiographic puff of smoke, the Japanese meaning of moyamoya. Fibromuscular dysplasia produces a string of beads appearance in mid cervical vessels, and carotid cavernous fistula produces early opacification of the cavernous sinus and ophthalmic veins.

Reference: Grainger and Allison's Diagnostic Radiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.