Moyamoya-induced paroxysmal dyskinesia

Area of Science:

• Neurology
• Vascular Neurology
• Movement Disorders

Background:

• Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of intracranial arteries.
• While typically presenting with stroke, MMD can manifest with other neurological symptoms.

Observation:

• This study reports two cases where paroxysmal dyskinesia, resembling paroxysmal kinesigenic dyskinesia (PKD) and paroxysmal non-kinesigenic dyskinesia (PNKD), was the initial symptom of MMD.
• A review of prior literature found no reported cases of moyamoya-induced chorea mimicking PKD or PNKD.

Findings:

• The presented cases highlight that MMD can manifest with specific types of paroxysmal dyskinesia as an early, presenting symptom.
• These involuntary movements may be linked to both hormonal influences and ischemic factors in MMD pathogenesis.

Implications:

• The findings suggest that MMD should be included in the differential diagnosis for patients presenting with paroxysmal kinesigenic dyskinesia and paroxysmal non-kinesigenic dyskinesia.
• This broadens the clinical recognition of MMD beyond typical stroke presentations, potentially leading to earlier diagnosis and intervention.