[A case of moyamoya disease accompanied by arterio-venous malformation]

It is well known that moyamoya disease is sometimes accompanied by cerebral aneurysm. However, a case of moyamoya disease with arterio-venous malformation is not found out on the literature. In this paper, a rare case of moyamoya disease accompanied by arterio-venous malformation is reported. The patient is a 33-year-old male who developed transient left motor weakness and visual disturbance on September 5, 1983. He was admitted to our hospital on October 3, 1983. On admission, there were no abnormal neurological findings. Plain CT scan showed low density area in the left parietooccipital cortex. Enhanced CT scan revealed a ribbon-shaped enhanced area in the right temporooccipital cortex and spotty enhanced area in the right frontal subcortex. Cerebral angiogram was a typical angiogram of moyamoya disease, namely, stenosis of the terminal portions of both internal carotid arteries and basal, ethmoidal and vault moyamoya vessels were seen. On the basis of Suzuki's angiographical classification the patient was diagnosed as being in stage III. Interesting was that a right carotid angiogram revealed an arterio-venous malformation fed by basal moyamoya vessels and drained to Trolard and Sylvian veins in the right frontal lobe. This arterio-venous malformation consisted with feeders, nidus and drainers. The size of arterio-venous malformation was about 8 X 11 X 12 mm on the angiogram. Another interesting fact was that Trolard vein which was one of the draining veins of the arterio-venous malformation flows into the right parietal vault moyamoya vessels as if it was feeding the moyamoya vessels.