Unilateral Moyamoya Disease in an Adolescent Female of Non-Asian Descent: A Case Report

Authors

  • Aaron Peterson, BS Kirk Kerkorian School of Medicine at UNLV, Las Vegas
  • Trinity Puno, BS Rocky Vista University - Montana College of Osteopathic Medicine, MT
  • Joshua Levy, MD Department of FM/Transitional Year Program, Sunrise Health GME Consortium, HCA Healthcare, NV
  • Angus Cheng, DO Department of FM/Transitional Year Program, Sunrise Health GME Consortium, HCA Healthcare, NV
  • Jabre Millon, MD Department of FM/Transitional Year Program, Sunrise Health GME Consortium, HCA Healthcare, NV
  • Tim Stone, MD Department of FM/Transitional Year Program, Sunrise Health GME Consortium, HCA Healthcare, NV
  • Isaac Wang, DO Department of FM/Transitional Year Program, Sunrise Health GME Consortium, HCA Healthcare, NV
  • Rajpaul Gill, MD Department of FM/Transitional Year Program, Sunrise Health GME Consortium, HCA Healthcare, NV
  • Millie Pal, DO Department of FM/Transitional Year Program, Sunrise Health GME Consortium, HCA Healthcare, NV
  • Kyle Mefferd, PhD Far West Division Research Team, HCA Healthcare, Las Vegas
  • Denise Vidal , MPH Far West Division Research Team, HCA Healthcare, Las Vegas
  • Angelina Rodriguez, MD Department of FM/Transitional Year Program, Sunrise Health GME Consortium, HCA Healthcare, NV
  • Upinder Singh, MD Department of FM/Transitional Year Program, Sunrise Health GME Consortium, HCA Healthcare, NV

DOI:

https://doi.org/10.3941/jrcr.5942

Abstract

Moyamoya disease (MMD) is an idiopathic occlusive cerebrovascular disease that affects the internal carotid artery, middle cerebral artery or anterior cerebral artery forming a smoke-like collection of blood vessels seen on digital subtraction angiography or magnetic resonance imaging/angiography (MRI/MRA). MMD most frequently occurs in East Asian populations and often leads to headaches, seizures, transient ischemic attacks or strokes. The cause of MMD has yet to be fully explained, but several studies have shown genetics play a factor in the development of MMD. The characteristic “puff of smoke” of MMD is most easily visualized with direct angiography and can be treated surgically with direct or indirect revascularization techniques. This article presents a unique case of moyamoya disease in a Hispanic pediatric patient involving the left middle cerebral artery who was treated with an indirect revascularization technique, encephaloduroarteriosynangiosis.

Cerebral angiography with the characteristic “puff of smoke sign” which describes the appearance of small, abnormal net-like vascular collateral networks in moyamoya disease. Occlusion of the middle cerebral artery M1 segment at its origin with extensive lenticulostriate collaterals with an angiographic appearance typical of a "puff of smoke" is visualized.

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Published

2026-01-01

Issue

Section

Neuroradiology