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>>> Q. Karanjit Singh, Atul Kapoor, Renu Gupta, Ravikaran Singh
Department of Pediatrics, Govt. Medical College, Amritsar, India

Address for Correspondence: Dr Karanjit Singh, D-124, Ranjit Avenue, Amritsar - 143001 Punjab, India. Email: kjspatti@yahoo.co.in


A nine year old boy was presented with sudden onset of inability to move right upper limb, inability to speak and blurring of vision. The weakness progressed to the lower limb one day after the admission. Two days later he started speaking few words accompanied by facial expression and head nodding movements. The child had similar type of sudden onset of weakness of left upper and lower limb at the age of 4 years, but remarkable improvement of weakness occurred over a period of 2 weeks after initiating physiotherapy. During the proceeding 4 years, the child developed repeated attacks of weakness of right upper limb.
On day 3rd of admission, the child became semiconscious, not recognizing even the mother indicating another bout of a stroke and , or extension of the previous attack. Upper motor type right facial palsy also appeared after the fresh attack.

MRI Brain showed acute non-hemorrhagic MCA zone and left super medial fronto parietal ACA zone infarction. Chronic right temporo parietal, occipital, frontal PCA, ACA, MCA, watershed and left frontal watershed infarcts present.

MRI angiogram is shown in the figure.

What is the diagnosis_?

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