Picture of the Month Quiz

A 2-month-old, previously healthy infant developed partial seizures, eventually controlled by anticonvulsants. Results of imaging studies and metabolic workup were normal. He was born full-term after an uncomplicated pregnancy and delivery, and development had been normal. At age 5 months, he suffered a left-sided hemiparesis due to a right anterior cerebral artery stroke. At age 11 months, he presented with a right-sided hemiparesis and focal right-sided seizures from a left middle cerebral artery stroke. Results of cardiologic evaluation, including echocardiography, were normal. Extensive hematologic workup and genetic screening for a hypercoagulable state were unrevealing. Magnetic resonance imaging and concurrent magnetic resonance angiography prompted conventional 4-vessel angiography (Figure).


What is your diagnosis?