Moyamoya-like Phenomenon in Middle and Anterior Cerebral Artery Occlusions in the Elderly.

Abstract

We present here five cases of moyamoya disease-like phenomenon in the elderly patients who had moyamoya vessels in the basal ganglia as a sequela of occlusion of middle cerebral artery (MCA) and/ or anterior cerebral artery (ACA). Ages ranged from 59 to 77 years (mean age: 67.6). Clinical manifestations included transient ischemic attacks (TIAs), reversible ischemic neurological deficits (RINDs) and mild hemiparesis. All the patients were living normal daily lives despite recurrent cerebral ischemic attacks. They had some risks of cerebrovascular disease, such as hypertension, and hyperlipemia. Angiography showed either MCA or ACA occlusion or both. Retrograde leptomeningeal filling of the ischemic region was maintained by the posterior cerebral artery (PCA) and ACA. Obstruction of the intracranial internal carotid artery was not visible. These neuroradiologic findings were not consistent with the criteria for moyamoya disease. The present cases may be related to congenital or acquired abnormalities in the main trunks of cerebral arteries.