Incidental Moyamoya Disease in an Elderly Patient Presenting With Acute Ischemic Pontine Stroke
Hadi Abou-El-Hassan1, Haroon Azhand2, Melvin Kantono2
1Neurology, Arrowhead Regional Medical Center, Colton, USA.
Abstract:
Moyamoya disease (MMD) is a rare occlusive cerebrovascular disease that is characterized by progressive stenosis of the terminal portion of the internal carotid artery and its main branches with compensatory development of dilated and fragile collateral vasculature at the base of the brain. MMD has a bimodal age distribution commonly affecting children and adults, whereas onset in the elderly population is a rare occurrence. Here, we present a case of a 78-year-old patient of Indonesian descent who was incidentally found to have moyamoya arteriopathy after presenting with acute ischemic stroke in the left pons. The patient underwent diagnostic cerebral angiogram that showed right middle cerebral artery stenosis with pathognomonic collateral moyamoya vessels. The patient was discharged on antiplatelet therapy. We report a rare case of an elderly patient with MMD. The role of medical or surgical management in asymptomatic MMD in elderly patients remains largely unknown.
Insights
This case report details a rare instance of moyamoya disease (MMD) in a 78-year-old patient, diagnosed after an ischemic stroke. The findings highlight the unusual presentation of MMD in the elderly.
Area of Science:
- Neurology
- Vascular Neurology
- Radiology
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular condition.
- It involves progressive stenosis of major cerebral arteries and development of collateral vessels.
- MMD typically affects children and adults, with rare onset in the elderly.
Observation:
- A 78-year-old Indonesian male presented with acute ischemic stroke.
- Incidental diagnosis of moyamoya arteriopathy was made.
- Cerebral angiogram revealed right middle cerebral artery stenosis and moyamoya vessels.
Findings:
- The case represents a rare occurrence of MMD in an elderly individual.
- Cerebral angiography confirmed the characteristic features of moyamoya disease.
- The patient was treated with antiplatelet therapy.
Implications:
- This case underscores the importance of considering MMD in elderly stroke patients.
- The optimal management strategies for asymptomatic MMD in the elderly remain unclear.
- Further research is needed to define the role of medical and surgical interventions in this demographic.
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