Unveiling Psychiatric Manifestations in a Case of Moyamoya Disease

Moyamoya disease (MMD) is a rare and progressive cerebrovascular disorder characterized by stenosis of the internal carotid arteries and their major branches, leading to the development of abnormal collateral vessels. While MMD is traditionally associated with ischemic and hemorrhagic strokes, there is increasing recognition of the psychiatric symptoms that can accompany the disease, which significantly impact patient outcomes and complicate management. This case report presents a 30-year-old female with a history of recurrent ischemic strokes, hypertension, diabetes, and dyslipidemia, who initially presented with neurological symptoms including headache, left-sided weakness, and facial deviation. Along with these neurological signs, the patient developed psychiatric symptoms, including depression and later, psychosis. After referral to the psychiatry liaison team, the patient was diagnosed with post-stroke depression, followed by the development of persecutory delusions and grandiosity. Psychiatric treatment with selective serotonin reuptake inhibitors (SSRIs) and antipsychotics led to significant improvement in mood and resolution of psychotic symptoms. This case highlights the importance of early identification and management of psychiatric manifestations in MMD patients. A multidisciplinary approach, incorporating both neurological and psychiatric interventions, is essential to optimizing patient care and improving outcomes.