Abstract
The authors describe the case of a 16-year-old, female, moyamoya disease patient who had undergone a bilateral superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis and an encephalo-myo-synangiosis (EMS). Subsequently, she experienced repetitive transient ischemic attacks (TIAs) of hemiparesis whenever each anastomosed STA was compressed, especially when pressure was sustained by her elbows while watching television or reading a book. Bilateral external carotid ARTERIOGRAMS revealed that each MCA region had good filling via each anastomosed STA, the EMS and transdural anastomoses, but a cerebral blood flow (CBF) SPECT study, using ^<99m>Tc-hexameth-ylene-propyleneamine oxime, showed that the CBF in the ipsilateral MCA decreased whenever each STA was compressed. It thus was felt that each MCA in this patient was dependent on the blood flow supply via the anastomosed STA, and that the collateral reserve, supplied via the vertebrobasilar arterial system and the other external carotid artery system, was poor.
