Disclosures: Francis Lee, DO: No financial relationships or conflicts of interest

Case Description: 26 year old female presenting with recurrent episodes of syncope, dizziness, and headache. She had a prior history of right frontal cerebrovascular accident and Moya Moya syndrome but was lost to follow up, and is now presenting approximately five years later. Images from outside institute, as well as repeat inhouse imaging confirmed the diagnosis of Moya Moya syndrome. Patient was taken in for surgery and had a Superior Temporal Artery (STA) to Middle Cerebral Artery (MCA) bypass performed. Post operatively she was noted to have persistent bilateral upper extremity weakness, with significant functional deficits.

Setting: Acute inpatient rehabilitation center in tertiary care hospital

Patient: 26 year old female with a history Moya Moya syndrome undergoing STA-MCA bypass surgery. Assessment/

Results: Prior functional status was independent with all activities of daily living. Immediately postoperatively, the patient was noted to have significant functional deficits. Patient was functionally only able to tolerate bed mobility with supervision for safety. Aggressive physical therapy and occupational therapy for three hours per weekday over the span of nine days allowed the patient to make significant functional gains. At discharge, patient was noted able to independently ambulate over 200′ without assistive device. Similar independence in other functional domains.

Discussion: Moya Moya syndrome is an uncommon clinical entity that can be managed with very specific surgical considerations such as STA-MCA bypass. Post operative complications include the risk of delayed stroke, seizure, intracranial hemorrhage and graft occlusion. Addressing post operative functional deficits in an acute inpatient rehab care setting provides surveillance for potential complications and supports an optimal environment for functional recovery.

Conclusion: Patients undergoing STA-MCA bypass surgery for management of Moya Moya syndrome often have a favorable functional outcome. Individualized treatment plan coordinated with a multidisciplinary team along with optimal medical management are all important factors in providing the best environment for these outcomes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/sta-mca-bypass-in-the-surgical-management-of-moya-moya-syndrome-a-case-report/