Repeated Transient Ischemic Attacks Caused by Hyperventilation in a Patient with Bilateral Occlusion of the Internal Carotid and Anterior Cerebral Arteries

Abstract

The authors discuss the case of an 11-year-old female admitted to our institute because of repeating transient ischemic attacks caused by hyperventilation. Cerebral angiography disclosed multiple occlusions of the bilateral internal carotid arteries and the left vertebral artery, and stenosis of the right vertebral artery. Moreover, distal portions of the occluded internal carotid arteries by basal moyamoya-like vessels was also visualized. However, cerebral angiograms showed the bilateral C_1 segments, the P_1 segments, the posterior communicating arteries, and the anterior communicating artery were still intact, and the circle of Willis, except for the A_1 region, was clearly recognized. Further, encephaloelectrograms revealed the typical re-build up phenomenon. This case presented a moyamoya disease-like pattern after hyperventilation, provoking the same hemodynamic mechanisms that cause ischemic attacks in patients with moyamoya disease.