Disclosures: Jordan A. Feierman, DO: Nothing to disclose

Case Description: During the patient’s hospital course, she became lethargic with dysarthria and an inability to follow commands, with right-sided facial droop and hemiparesis. Computed tomography (CT) of the head demonstrated no intracranial hemorrhage. CT perfusion scan of the head showed an acute left middle cerebral artery (MCA) infarction with a large region of penumbra. The patient was not a candidate for tissue plasminogen activator (tPA) having had recent surgery. The interventional radiology team attempted a cerebral angiogram, however, no endovascular intervention was possible due to chronic bilateral supraclinoid internal carotid arteries (ICAs) with multiple collaterals consistent with Moyamoya disease (MMD).

Setting: Acute Hospital

Patient: A 66-year-old female was admitted for diverticulitis and underwent post robotic sigmoid colectomy.

Assessment/Results: The patient was started on full dose aspirin and a high intensity statin for secondary stroke prophylaxis and treated with aggressive physical, occupational, and speech therapy on the inpatient rehab unit with subsequent improvement in deficits.

Discussion: The literature describes several cases of MMD and compares the differences in management of transient ischemic attack (TIA), ischemic cerebral vascular accident (CVA), and hemorrhagic CVA with MMD.

Conclusion: MMD is a rare phenomenon which may result in severe neurological compromise. More studies are needed to address management of this condition and its sequelae.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-stroke-in-a-patient-with-radiologic-findings-of-moyamoya-disease-a-case-report/