Document Type

Article

Publication Date

2026

Abstract

Moyamoya is a chronic progressive cerebrovascular disorder characterized by gradual stenosis and eventual occlusion of the intracranial vessels. The disease most commonly begins in the intracranial internal carotid arteries and may extend to involve the anterior, middle, and posterior cerebral arteries. As arterial narrowing progresses, a network of fragile collateral vessels forms at the base of the brain, creating the characteristic “puff of smoke” appearance seen on angiographic imaging.

This case study reviews a 43-year-old male who presented with an acute ischemic stroke involving a functionally occluded right M1 segment of the middle cerebral artery (MCA), later determined to be secondary to Moyamoya. Diagnostic evaluation included transcranial doppler (TCD), vasomotor reactivity (VMR) testing, computed tomography angiography (CTA), and magnetic resonance angiography (MRA), which together demonstrated impaired cerebral perfusion and reduced vascular reserve. Based on these findings, the patient underwent a superficial temporal artery to middle cerebral artery (STA–MCA) bypass for surgical revascularization.

This case emphasizes the importance of early detection, appropriate imaging, and timely intervention in managing Moyamoya disease to reduce the risk of recurrent ischemic events and long-term neurologic complications.

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