Puff of smoke appearance on cerebral angiography is seen in: Moyamoya disease

Puff of smoke appearance on cerebral
angiography is seen in:
a) ACA aneurysm
b) Cavernous sinus thrombosis
c) Moyamoya disease
d) Vein of Galen malformation
Correct Answer - C
Ans. c. Moyamoya disease
Moyamoya disease is an idiopathic, non inflammatory, non
atherosclerotic progressive vasculo-occlusive disease involving the
circle of Willis, typically the supraclinoid internal carotid arteries.
Small abnormal net-like vessels proliferate giving the
characteristic “puff of smoke” appearance on direct
angiography. CTA and MRA is not always able to demonstrate this
appearance on account of lower flow and spatial resolution