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nialDopplerultrasonography.These evaluationtoolsconcentratemainly on the degree of stenosis and relatedhemodynamicfactors,butthey fail to provide information about wallstructures.High-resolutionMRI iscurrentlytheonlynoninvasivetool fortheevaluationofintracranialatherosclerotic plaques. Several recent studies 1-3 have confirmed the feasibility of using high-resolution MRI to depict the MCA plaque. In our case, the MCA plaque exhibited inhomogeneous components with high and low signal intensities within itself. The plaque withfocalcalcificationwasrigidand refractory to angioplasty, even after using high-pressure balloon expansion. We presumed that the heterogeneous signal intensity of plaques may represent various plaque compositions. These plaque characteristics may be clinically meaningful, especially in the endovasculartreatmentofintracranialartery stenosis.

ObjectiveTo report a case of progressive facial hemiatrophy with unusual features of contralateral brain atrophy and transcranial Doppler ultrasound evidence of autonomic dysfunction.DesignCase report.SettingA teaching hospital.PatientA 63-year-old man who presented with a 10-year history of progressive right-sided facial atrophy and recent facial pain.ResultsBrain magnetic resonance imaging revealed left frontoparietal atrophy. Transcranial Doppler ultrasound demonstrated evidence of autonomic dysfunction ipsilateral to brain atrophy.ConclusionThis case expands the spectrum of findings in progressive facial hemiatrophy to include contralateral brain atrophy and suggests that sympathetic dysfunction might play a pathogenic role in progressive facial hemiatrophy.