Abstract
Moyamoya disease (MMD) is a rare intracranial vasculopathy characterized by the progressive occlusion of the terminal internal carotid arteries and their proximal branches. Various factors including genetic and inflammation are the proposed pathogenesis of MMD. We present a case of a 31-year-old man who had recurrent stroke secondary to MMD. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) demonstrated an infarct in the right middle cerebral artery (MCA) territory, and stenosis of the terminal right internal carotid artery (ICA) and its proximal branches. He initially declined surgical management and was treated with antiplatelet. After his third stroke, he finally underwent right superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery. He improved following rehabilitation with no further recurrence. The role of surgical revascularization in the prevention of stroke is well-described in the literature but evidence regarding medical therapy remain scarce and will be explored in this report.
Highlights
Stroke remains a major health burden worldwide
We present a case of a 31-year-old man who had recurrent stroke secondary to Moyamoya disease (MMD)
Moyamoya disease (MMD) is one of the causes of stroke among the young, characterized by the progressive stenosis of large intracranial arteries leading to ischemia of the basal ganglia [3]
Summary
Stroke remains a major health burden worldwide. Stroke in a young person can be devastating due to the loss of productive years and impact on the young person's life [1]. He was seen by a neurosurgeon, but he declined surgical intervention at that stage as he was worried about the possible complication of the surgery He was managed conservatively with physical rehabilitation and optimization of his cardiovascular risk factors such as smoking cessation, as well as secondary prevention medications (aspirin 150mg OD, simvastatin 40mg ON and perindopril 4mg). He continued to improve with minimal residual weakness. He regained full neurological functions following regular rehabilitation sessions During his follow up visit seven months after the surgery, his cardiovascular risk factors were optimized with a blood pressure of 125/80 mmHg, low-density lipoproteins (LDL) of 1.8 mmol/litre, high-density lipoproteins (HDL) of 1.2 mmol/ litre, total cholesterol of 3.5 mmol/ litre and fasting blood glucose of 5.1 mmol/ litre. He was able to quit smoking with support from his primary care doctors
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