A 16 year old girl presented with complaints of weakness in all four limbs associated with left sided involuntary movements, headache and bowel incontinence since one month.
On T1/T2 sequences, MRI of the brain shows prominent flow voids in the basal ganglia, lenticulostriate and periventricular white matter flow voids. The time of flight angiography shows severely attenuated internal carotid arteries with multiple collaterals at the base of the brain.