Abstract
A case of a right middle cerebral arterial occlusion, with moyamoya phenomenon, showing a subependymal hemorrhage was reported.
A healthy 17-year-old man complained a pulsative frontal headache, nausea, and vomiting when playing baseball. Three days later he had stiff neck and was admitted to our hospital on Sept. 18, 1982.
On admission, he was drowsy and showed no involuntary movements, paresis and sensory disturbances. Sluggish light reflex was present, and a lumbar puncture yielded a xanthochromic spinal fluid under the initial pressure of 200mmH2O. ACT scan obtained on the third day of admission showed a subependymal hemorrhage.
The right internal carotid angiography revealed the occlusion of right middle cerebral artery at the M1 portion, with moyamoya phenomenon and the transdural anastomosis was present.
The left internal carotid angiography revealed no moyamoya phenomenon, sclerosis, or occlusion. The right vertebral angiography revealed no arterial stenosis or occlusion, but leptomeningeal anastomosis of the posterior pericallosal artery was present.
On the 18th day of admission, there was perfect recovery of consciousness, light reflex, and neck stiffness without complication. There was no change in findings observed in angiography, one year after discharge.
This case demonstrated only an unilateral, middle cerebral arterial occlusion in the M1 portion associated with moyamoya phenomenon on angiograpy. This findings does not fully satisfy the criteria of moyamoya disease, so this case may be one of moyamoya-like disease. However, the angiographic findings in this case has the same characteristic finding of idiopathic middle cerebral arterial occlusion, reported recently.
A long term follow up is necessary in order to make an exact diagnosis in this case. It may be emphasized that, one must be careful to make the diagnosis of moyamoya disease, especially when moyamoya phenomenon was associated with unilateral middle cerebral arterial occlusion.
