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Pediatric Moyamoya Disease in Nepal and Challenges in a Resource-Limited Setting: A Case Report

Kapil Khanal1, Sunil Dhungana2, Bindu Gyawali2

  • 1Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM) Tribhuvan University (TU) Kathmandu Nepal.

Clinical Case Reports
|October 9, 2025
PubMed

Insights

Moyamoya disease (MMD), a rare cerebrovascular disorder, was diagnosed in a Nepali child presenting with stroke-like symptoms. Conservative management provided partial recovery, highlighting MMD

Area of Science:

  • Neurology
  • Pediatric Neurology
  • Vascular Neurology

Background:

  • Moyamoya disease (MMD) is a rare, progressive cerebrovascular disorder.
  • Characterized by internal carotid artery stenosis and fragile collateral vessels.
  • Underreported in Nepal, though common in East Asia; pediatric cases present with ischemic symptoms.

Purpose of the Study:

  • To report a pediatric case of Moyamoya disease in Nepal.
  • To highlight diagnostic and management considerations in a resource-limited setting.

Main Methods:

  • Case report of a 7-year-old boy with fever, seizures, and hemiparesis.
  • Diagnostic workup included MRI and MR angiography.
  • Conservative management with aspirin and levetiracetam was initiated.

Main Results:

  • MRI/MRA confirmed Moyamoya disease with multiple infarcts and carotid stenosis.
  • Cerebrospinal fluid and autoimmune markers were unremarkable.
  • The patient showed partial recovery with conservative treatment; surgery was deferred.

Conclusions:

  • Moyamoya disease should be considered in pediatric stroke cases, even in non-endemic regions.
  • Conservative management can offer symptomatic relief in resource-limited settings like Nepal.
  • Long-term follow-up is crucial for monitoring disease progression and surgical needs.
Keywords:
antiplatelet therapycerebrovascular disorderconservative managementmoyamoya diseasepediatric stroketransient ischemic attack

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