Abstract
Quasi moyamoya disease is the unilateral form of typical moyamoya disease which is associated with acute or chronic stages of inflammatory diseases. Here, I present 21-year-old boy presented with sudden onset of weakness of right sided limbs following physical workout, had acute ischemic infarction of left internal capsule in diffusion restriction MR image and unilateral steno- occlusive changes of terminal portion of left internal carotid artery was noted in digital subtraction angiography.
Highlights
Moyamoya Disease (MMD) was defined in 1969 by Suzuki and Takaku,[1] is a progressive cerebrovascular disorder characterized by progressive stenosis of the terminal portion of the bilateral internal carotid arteries
Weakness was sudden in onset following physical work out
There was a history of dull aching type of pain over left eye 3 days back which resolved within a day without any medications
Summary
MRI brain demonstrated acute ischemic infarction over the posterior limb of left egneuro Volume 03, Issue 01, 2021 internal capsule (Figure 1A). Digital subtraction Angiography (DSA) lateral oblique view revealed small caliber internal carotid artery (ICA) with beading appearance. Steno-occlusive changes of terminal portion of left internal carotid artery with initial appearance of moyamoya vessels showing early “puff of smoke” was noted. Another study had demonstrated association between increase levels of (Matrix Metalloproteinase) MMP-9, (Hepatocyte Growth Factor) HGF in CSF and MMD. These factors have potent role in induction of development of new vessels. Digital subtraction angiography lateral oblique view demonstrating steno-occlusive changes of proximal ICA with early development of moyamoya vessel (puff of smoke) (B)
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