A Case of Progressive Stenosis of Bilateral Internal Carotid Bifurcation with Moyamoya Vessels which Aggravated Shortly after Head Trauma

Abstract

A case of progressive stenosis of bilateral I-C bifurcation with Moyamoya vessels which aggravated shortly after head injury was reported.
A 28-year-old man was admitted to our hospital about 40 minutes after car-accident. He was unconscious and had right hemiparesis.
Bilateral carotid angiogram revealed no finding of intracranial hematoma but stenosis of bilateral. internal-carotid bifurcations. CT scan showed irregular high density area in the left temporo-occipital region.
On the 6th day after trauma, stenosis of left I-C bifurcation increased. About two months after trauma, stenosis aggravated progressively and Moyamoya vessels appeared angiographically.
On the other hand, right carotid angiogram taken one month after trauma showed progressive stenosis and Moyamoya vessels as well.
It is difficult to determine wheather it is traumatic stenosis or cerebrovascular Moyamoya disease.
We discussed the possible mechanism of stenosis of bilateral internal-carotid bifurcation and appearance of Moyamoya vessels.