Title : Progressive Steno-Occlusive Syndrome: Moyamoya Disease
Presenter : Ulviyya Gasimova, USA
Introduction : Moyamoya is a rare disease with reported incidence of 0.086 per 100,000 population Moyamoya disease is deemed a progressive steno-occlusive disease at terminal portions of the bilateral internal carotid arteries with the development of “moyamoya vessels” as collateral channels of circulation .
Case Report : A 50 year-old white Caucasian male with known history of diabetes mellitus, hypertension, hyperlipidemia and severe, multiple vascular diseases in the setting of moyamoya disease. In 2009, the patient developed stroke in territory of right MCA and thoracic spinal cord infarction which rendered him with residual left-sided numbness, left lower extremity weakness. The patient also has a history of severe right carotid stenosis and multiple TIAs. In July 2016, the patient presented with worsening lower extremity weakness and incontinence. A diagnosis of Transverse Myelitis was made. After five days course of IV Solu-Medrol, the patient’s symptoms improved.
On June 2016, a CT angiogram head with contrast showed stenosis within the right intracranial internal carotid artery with chronic occlusion of the M1 segment. A collateralized flow was visualized as well. A CT angiogram of the neck revealed a plaque and calcification at the right carotid bulb with resultant marked narrowing (>90% occlusion) in the proximal right Internal Carotid Artery with resultant pinpoint flow in the occluded area. Moreover, an atherosclerotic plaque and calcification were seen in the left carotid bulb with approximately 50-69% stenosis in the proximal left Internal Carotid Artery.
A MRI for the brain was also done which showed, in addition to the aforementioned findings, multiple chronic infarcts within the right MCA- ACA and MCA-PCA watershed distributions. These findings were the same when compared to radiological studies done in 2011.