A six-month-old male who presented with acute right hemiparesis. DWI (A) demonstrates acute infarct in the left basal ganglia and deep white matter (white arrow). MRA (B) shows severe stenosis of the left M1 middle cerebral artery segment (black arrow). Follow-up 4 months later, demonstrates evolution of the infarct, now with encephalomalacia and gliosis without new acute infarct (white arrowhead) (C). MRA at that times shows mild improvement but persistent MCA stenosis (black arrowhead) (D). Findings are most compatible with focal cerebral arteriopathy.