Medical history 9-year-old male patient with SS hemoglobinopathy, followed at Hemominas' clinic in Belo Horizonte. In 2010, it was carried out examination of transcranial Doppler, which showed increased blood flow velocity in the middle cerebral arteries bilaterally, showing high risk for ischemic stroke, and it was initiated transfusion regimen for primary prevention of the event. It was then ordered an MRI of the brain and its angiographic reconstruction (attached images).Image 1: MRI of the brain, diffusion weighted, axial section.Image 2: MRA (Magnetic Resonance Angiography) of the brain, 3D-TOF technique without contrast, axial section.Image 3: MRA of the brain, 3D-TOF technique without contrast, axial section.Image 4: Angiographic reconstruction of MRA of the brain.Question:Based on clinical history and the submitted images, which is the most likely diagnosis? Hemorrhagic stroke Chronic Occlusive Cerebrovascular Disease (Moyamoya disease) Stenosis and neovascularization at the level of the middle cerebral artery (Moyamoya phenomenon) Fusiform aneurysm of cerebral arteries Time is Up! Time's up
