Introduction
Moyamoya disease (MMD) is a rare cause of cerebral vascular ischemia,
which is radiologically featured as progressive stenosis of the distal
part of the internal carotid artery and the formation of capillary
collaterals (1). It can affect any age, children and adults, while
ischemic manifestations are more common in pediatric cases, whereas
hemorrhagic cases are more common in adults. Diagnosis relies on imaging
techniques, which include CT, MRI and angiography (2). The disease can
progress from unilateral to bilateral involvement, with specific
clinical and genetic factors potentially influencing this progression
(3). Intracranial haemorrhage is a significant concern, with about half
of the adult-onset MMD patients experiencing it. Cerebral ischemia is
the most common manifestation, affecting 73.9% of elderly patients
along with speech and cognitive impairment (4,5). Cognitive dysfunction
is a significant issue in adult MMD patients, particularly affecting
those with difficulty in social independence. A broad range of cognitive
functions can be disrupted, including basic abilities and frontal lobe
function (6). While the optimal treatment strategy remains debated,
personalized selection based on patient characteristics and disease
severity is crucial for balancing perioperative risks and long-term
benefits in MMD management. MMD treatment primarily involves cerebral
revascularization through direct or indirect bypass procedures. Direct
bypass, such as superficial temporal artery-middle cerebral artery
(STA-MCA) anastomosis, provides higher revascularization rates and
potentially better clinical outcomes (7).
Herein, we will discuss a 20-year-old male, non-smoker and non-alcohol
consumer with a diagnosis of MMD, which is a rare chronic cause of
stroke.