Moyamoya disease presenting with acute subdural hemorrhage

Amit Kumar Ghosh 
 Department of Neurosurgery, Medica North Bengal Clinic, Siliguri, West Bengal, India

Correspondence Address:
Amit Kumar Ghosh
Department of Neurosurgery, Medica North Bengal Clinic, Siliguri, West Bengal
India

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Sir,

Moyamoya disease is characterized by progressive occlusion of distal internal carotid artery and its branches resulting in ischemic infarcts and collateral formation as a compensatory mechanism [1] Angiographic appearance of this collateral network is like "puff of smoke" which in Japanese language called "moyamoya." [1] Moyamoya disease itself is very rare and is more common in Japanese population. [1],[2] This report presents a rare presentation of moyamoya disease.

A 46-year-old male presented with sudden onset loss of consciousness followed by headache and vomiting. Computed tomography scan showed right acute subdural hematoma (SDH) with mass effect [Figure 1]. Neurologic examination revealed altered mental status and left hemiparesis. Considering nontraumatic nature of hemorrhage, magnetic resonance angiography was done and it showed right internal carotid artery occlusion. As there was neurologic deterioration, right decompresive craniotomy and evacuation of SDH was done [Figure 2]. Patient had good recovery. Postoperative digital subtraction angiography had confirmed moyamoya disease [Figure 3]. He was discharged in a stable condition with future plan of revascularization.{Figure 1}{Figure 2}{Figure 3}

Moyamoya disease in pediatric patients, presents with ischemic events and intracranial hemorrhage accounts only for 10%, whereas in adults intracranial hemorrhage accounts for more than 60% of cases. [3] Spontaneous acute SDH in moyamoya disease is rare and only 6 cases have been reported. [4],[5],[6],[7],[8] This is yet another case. SDH as a complication of moya and moya is due to the rupture of transdural anastomotic vessels.

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