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.