A 52-year-old woman with beading of intracranial arteries

A 52-year-old woman of Indian ethnicity with a history of well-controlled hypertension, hyperlipidaemia and recurrent transient ischaemic attacks presented with altered mentation and slurred speech. Physical examination revealed generalised weakness. Initial blood tests showed raised total white cell count, raised erythrocyte sedimentation rate at 35mm/h and fasting low-density lipoprotein of 1.7mmol/L. Magnetic resonance imaging (MRI) of the brain showed small acute infarcts scattered in bilateral deep white matter (Fig. 1A), with extensive periventricular, deep and subcortical white matter leukoariosis (Fig. 1B) indicative of advanced small vessel disease. Angiography showed stenosis along the right anterior cerebral artery and beading of the left posterior cerebral artery (Fig. 1C). Digital subtraction angiography (DSA) showed beading along the right posterior cerebral artery (Fig. 1D).Published versio