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Unilateral Absence of the Basal Ganglia on 123I-Ioflupane DaTScan
Yaser Baghdadi1, Se Jin Anh2, Allan Brook2
1From the Divisions of Nuclear Medicine.
Clinical Nuclear Medicine
|July 27, 2019
Summary
Moyamoya disease can cause hemorrhagic stroke and basal ganglia dysfunction. This case highlights potential complications like aneurysm re-perforation and tremor following treatment.
Area of Science:
- Neurology
- Neuroimaging
- Neurosurgery
Background:
- Moyamoya disease is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries and their branches.
- It can lead to ischemic or hemorrhagic stroke, often in young adults.
Observation:
- A 33-year-old man with moyamoya disease presented with hemorrhagic stroke (left hemiparesis, right ptosis).
- Angiography showed collateral filling via the posterior circulation due to occluded carotids.
- A right basilar tip aneurysm was treated with coil placement, but later perforated, requiring a second procedure.
Findings:
- Post-treatment, the patient developed a left hand tremor.
- A DaTscan revealed absent basal ganglia activity on the right side.
- This may be attributed to occlusion of the middle cerebral artery's lenticulostriate branches.
Implications:
- This case underscores the complex management of moyamoya disease, including aneurysm treatment and potential neurological sequelae.
- It highlights the importance of neuroimaging and DaTscan in evaluating post-stroke complications and movement disorders.
- Understanding the pathophysiology of moyamoya and its associated risks is crucial for patient outcomes.
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