Session Information
Session Title: AA 2021 Virtual Posters - Neurological Rehabilitation
Session Time: None. Available on demand.
Disclosures: Jennifer M. Cushman, MD: No financial relationships or conflicts of interest
Case Diagnosis: 52 yo female patient presenting with new onset stroke requiring acute inpatient rehabilitation to treat residual left-sided weakness, sensory deficits and cognitive impairments.
Case Description: Patient with residual left-sided weakness and sensory deficits secondary to Moyamoya disease requiring initial emergent hemicraniectomy for decompression, with-later scheduled cranioplasty and Encephaloduroarteriosynangiosis (EDAS) to restore cerebral blood flow.
Setting: Acute Inpatient Rehabilitation Stand-Alone FacilityAssessment/
Results: Patient with stroke secondary to Moyamoya disease with confirmed CTH-imaging showing multifocal areas of hypodensity in the right-frontal, anterior temporal, right basal ganglia and continued evolution of the multifocal areas of hemorrhage along with stable right-frontal/anterior temporal/ basal ganglia hypoattenuation, with stable layering blood-products in this region. The patient underwent EDAS-procedure to restore blood flow to areas of cerebral ischemia. This patient also had intracerebral hemorrhage secondary to the tiny aneurysms within the fragile network of collateral circulation. Patient also had several episodes of tachycardia making the patient high-risk during therapy with unknown past history of coronary pathology.
Discussion: Moyamoya syndrome is a vasculopathy with chronic-progressive stenosis of the arteries supplying the brain along with a fragile network of blood vessels that attempt to supply the ischemic regions in order to compensate-resulting in stroke and cognitive impairments. Digital Subtraction Angiography (DSA) diagnosed this patient with Moyamoya affecting MCA/ACA. Initially she had decompression-craniotomy, then 2 months later had Cranioplasty and EDAS-procedure using the superficial temporal artery to restore blood flow.
Conclusion: Moyamoya syndrome is a type of vasculopathy characterized by progressive stenosis of the arteries supplying the brain. Some literature demonstrated case reports of cardiac vessels also being affected. This patient had residual left upper and lower extremity weakness secondary to increased intracranial pressure from initial evolving hemorrhage. Before second rehab admission, EDAS procedure was performed in order to restore blood-flow to the ischemic regions of the brain to begin comprehensive care from the multidisciplinary rehabilitation team. This case reports raises an important question as to whether or not to undergo a full cardiac work-up in patients presenting with Moyamoya before admitted to comprehensive rehabilitation therapy.
Level of Evidence: Level V
To cite this abstract in AMA style:
Cushman JM, Elashvili M. When a “Puff of Smoke” Leads to a Stroke. A Closer Look at the Collateral Fragile Network of Blood Vessels That Develop in Bilateral Moyamoya: A Case Report [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/when-a-puff-of-smoke-leads-to-a-stroke-a-closer-look-at-the-collateral-fragile-network-of-blood-vessels-that-develop-in-bilateral-moyamoya-a-case-report/. Accessed May 14, 2025.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/when-a-puff-of-smoke-leads-to-a-stroke-a-closer-look-at-the-collateral-fragile-network-of-blood-vessels-that-develop-in-bilateral-moyamoya-a-case-report/