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Intermittent Hemiplegia in a Boy with Primary Moyamoya Disease: A Case Report from Iran
Reza Bidaki1,2, Ehsan Zarepur3
1Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Abstract:
Moyamoya is a rare chronic progressive occlusive cerebrovascular disease. Its manifestation varies from stroke, progressive learning impairment and transient ischemic attack to headache and seizure. There is no accepted medical treatment and surgery usually, is needed. We report here a case of 8 yr old boy referred to psychiatrist outpatient. An eight yr old boy with intermittent hemiplegia was brought to Imam Ali Clinic, Yazd, Iran in 2015 because his headache and medical problem began from 6 yr old. Stress and excitement exacerbated his condition. His first attack was at the age of 6 yr old. During attack, he had incontinence, severe headache, alogia, pallor, claudication and left hemiplegia (Left lower limb). Magnetic resonance angiography (MRA) was done and our diagnosis was moyamoya disease. Moyamoya is a mysterious disease and psychiatrists should consider it in differential diagnosis of alogia and plegia. Acute management of this disease is mainly symptomatic. Nowadays, surgery is a good choice and early diagnosis of this disease can change our patient's life.
Insights
Moyamoya disease, a rare cerebrovascular condition, can present with neurological symptoms like hemiplegia. Early diagnosis and surgical intervention are crucial for managing this progressive occlusive disease.
Area of Science:
- Neurology
- Vascular Neurology
- Pediatric Neurology
Background:
- Moyamoya disease is a rare, progressive, occlusive cerebrovascular disorder.
- It typically manifests with symptoms ranging from stroke to transient ischemic attacks.
- Currently, there is no definitive medical treatment, often necessitating surgical intervention.
Observation:
- A case report of an 8-year-old boy presenting with intermittent hemiplegia and headache since age 6.
- Symptoms were exacerbated by stress and excitement, including incontinence, severe headache, alogia, pallor, claudication, and left hemiplegia.
- Magnetic Resonance Angiography (MRA) confirmed the diagnosis of Moyamoya disease.
Findings:
- Moyamoya disease diagnosis was confirmed via MRA in an pediatric patient.
- The patient experienced recurrent episodes of left hemiplegia and significant headaches.
- Psychiatric symptoms such as alogia were noted during episodes.
Implications:
- Psychiatrists should consider Moyamoya disease in the differential diagnosis for patients presenting with alogia and plegia.
- While acute management is symptomatic, early diagnosis and surgical options can significantly alter patient outcomes.
- This case highlights the importance of considering rare neurological conditions in pediatric patients with complex symptoms.
