Key clinical message

Moyamoya disease, though rare, should be considered in young patients presenting with stroke-like symptoms, especially in the absence of traditional risk factors such as smoking, hypertension, or substance abuse. In this case, the diagnosis was confirmed through advanced imaging techniques, which revealed the characteristic narrowing of the internal carotid arteries and the formation of collateral vessels. Early recognition and appropriate medical management with aspirin led to symptomatic improvement. This case emphasizes the need for prompt investigation in young individuals with cerebrovascular events and highlights the critical role of imaging in diagnosing MMD, enabling early intervention to prevent recurrent ischemic events.