Radiation-induced moyamoya disease after childhood astrocytoma

Adjunctive radiation treatment of childhood intracranial neoplasms of grade II or higher creates a risk of subsequent vasculopathy. A 28-year-old male presented with a Glasgow Coma Scale 12 after acute collapse and hemiparesis with an intraparenchymal haematoma. Emergent craniotomy, histopathology and subsequent imaging confirmed the cause as radiation-induced moyamoya disease, subsequent to treatment for a grade 2 astrocytoma 24 years previously. He had been lost to follow-up after normal serial imaging performed up to 10 years after his initial diagnosis. Long term surveillance imaging may be of benefit in identifying treatable vascular anomalies.