Moyamoya disease: an unusual cause of cerebral infarction

A South African Bantu patient presenting with recurrent strokes and a change in personality was found to have cerebral infarction due to moyamoya disease. The disease has a characteristic radiological pattern of narrowing or occlusion of the distal internal carotid arteries associated with a profuse vascular network at the base of the brain and in the basal ganglia: the moyamoya vessels. The clinical features and the collateral vascular pathways that may develop after cerebral vascular occlusion are discussed and the surgical options for increasing cerebral blood flow described. In this patient a development of the technique in which the superficial temporal artery is laid onto the brain without interruption of the donor vessel was used, with improvement in the clinical picture.