Moyamoya syndrome in a young person with Down syndrome: diagnostic and therapeutic considerations.

Journal Article (Journal Article)

An 18-year-old woman with a history of Down syndrome (DS) presented with left upper extremity weakness. Neurological examination revealed moderate hypotonia throughout, with mild spasticity of the left ankle. She had 2/5 left upper and lower extremity strength, mild pronation with drift in the left arm and 3+ deep tendon reflexes in the left biceps, brachioradialis, patellar and Achilles. Strength was 5/5 in the right upper and lower extremities. A CT angiography of the head and neck with contrast demonstrated severe narrowing of the bilateral supraclinoid internal carotid arteries (ICAs), suggestive of moyamoya pattern. A diagnostic angiography confirmed stenosis in the right and left supraclinoid ICAs. The patient was started on aspirin therapy and underwent an indirect bypass procedure via encephaloduroarteriosynangiosis 6 weeks after initial presentation. DS is associated with a high risk of congenital heart disease, which in turn increases risk of stroke, namely cardioembolic events, including moyamoya disease. Intellectual disability is nearly ubiquitous in DS, thus adding to the challenges of making a diagnosis of moyamoya in this population.

Full Text

Duke Authors

Cited Authors

  • Rose, DK; Chamberlain, L; Ashton, J; Yaghi, S; Hauck, EF; Mac Grory, B

Published Date

  • March 4, 2022

Published In

Volume / Issue

  • 15 / 3

PubMed ID

  • 35246432

Pubmed Central ID

  • PMC8900050

Electronic International Standard Serial Number (EISSN)

  • 1757-790X

Digital Object Identifier (DOI)

  • 10.1136/bcr-2021-246168

Language

  • eng

Conference Location

  • England