# Moyamoya disease in a 10-year-old male patient in the Middle East with the outcome of the surgery: A case report and literature review

## TL;DR

A 10-year-old boy in Palestine with Moyamoya disease had surgery, but developed a stroke afterward, highlighting the need for early diagnosis and monitoring in children.

## Contribution

This is a rare case of Moyamoya disease in Palestine, emphasizing the importance of considering MMD in children with unexplained neurological symptoms.

## Key findings

- The patient experienced a stroke three days after indirect revascularization surgery.
- Moyamoya disease is uncommon in Palestine and requires prompt treatment and postoperative monitoring.
- Neurological symptoms in children should include MMD in the differential diagnosis.

## Abstract

A chronic cerebrovascular illness called Moyamoya disease (MMD) causes the internal carotid artery and the circle of Willis to narrow. Children can benefit from indirect bypass surgery, a procedure that is widely practiced in East Asia. It's critical to address postoperative problems early.

A 10-year-old male presented with syncope and loss of consciousness at the age of 9 years, followed by headaches, slurred speech, and aphasia. Imaging revealed acute ischemia in the left MCA territory. Lab tests showed coagulation abnormalities, and he was referred for stroke treatment. Eleven months later, he had another episode with headaches and vomiting; imaging showed chronic ischemic damage and a new infarction in the right temporal lobe. He underwent indirect revascularization but deteriorated postoperatively, developing hypoactivity, aphasia, and limb weakness. A CT scan indicated new ischemic changes. Six months before the last visit, he presented with tetraparesis, dysarthria, and blindness and was referred for rehabilitation.

Moyamoya disease is a rare cerebrovascular condition characterized by cerebral ischemia or hemorrhage. The condition is linked to thinning of blood vessel walls, decreased blood flow, and neurological symptoms like speech loss or weakness. It is characterized by intracerebral internal carotid artery stenosis and abnormally produced collateral arteries. Cerebral cortical artery revascularization is the primary surgical treatment, but it can also cause other unusual symptoms.

In Palestine, Moyamoya disease is uncommon and needs to be treated right away. It's critical to monitor stroke following surgery and take MMD into account when making a differential diagnosis for neurological symptoms in children.

•Rare case in Palestine: A toddler from Palestine developed Moyamoya disease (MMD) in a rare case that was made worse by a stroke following surgery.•After indirect revascularization surgery, the patient experienced a stroke three days later.•Pediatric MMD: This article draws attention to the necessity of considering MMD when a child exhibits neurological symptoms that cannot be explained.•Operative strategy: Indirect revascularization was the first therapy strategy, and it usually works well for children.

Rare case in Palestine: A toddler from Palestine developed Moyamoya disease (MMD) in a rare case that was made worse by a stroke following surgery.

After indirect revascularization surgery, the patient experienced a stroke three days later.

Pediatric MMD: This article draws attention to the necessity of considering MMD when a child exhibits neurological symptoms that cannot be explained.

Operative strategy: Indirect revascularization was the first therapy strategy, and it usually works well for children.