[A case showing angiographically moyamoya vessels combined with intracranial calcification]

This case was 36-year-old female with the past history of pulmonary tuberculosis on her 10 years old. During the treatment for pulmonary tuberculosis, transient tetraparesis appeared, and improved completely. She was admitted to our hospital, complaining sensory disturbance of left face and arm on July 25, 1983. Plain skull roentogenogram showed calcification at the base of brain. Computerized tomography (CT scan) showed dilatation of lateral and third ventricles. Cerebral angiograms revealed an occlusion of the right internal carotid artery and the left middle cerebral artery, the stenosis of the basilar artery and bilateral posterior cerebral arteries, transdural anastomosis (so-called vault moyamoya), leptomeningeal anastomosis and moyamoya vessels at the base of brain. Four days after the admission, left hemiplegia appeared suddenly. Because the findings of CT scan and angiogram showed no change, conservative treatment was performed and motor disturbance improved. Biopsy of the calcified mass was carried out and histological findings suggested an old inflammation. Based on the clinical course and examination, it was considered that moyamoya vessels of this case had been formed as a result of tuberculous meningitis. Up to now, only 6 cases with moyamoya vessels at the base of brain coursed by tuberculous meningitis Up to now, only 6 cases with moyamoya vessels at the base of brain coursed by tuberculous meningitis have been reported. In our case, neurological symptoms appeared 26 years after tuberculous meningitis and occlusive changes were seen in bilateral carotid system and vertebrobasilar system.