A case of unilateral moyamoya disease suffered from intracerebral hemorrhage due to the rupture of cerebral aneurysm, which appeared seven years later
A 61-year-old woman without any risk factor of arteriosclerosis visited a nearby hospital because of mild head injury. Magnetic resonance (MR) imaging demonstrated no apparent traumatic lesion. However, flow-void sign of the right middle cerebral artery was sluggish []. Cerebrovascular disease was suspected and she was referred to our hospital for further examination. She was neurologically intact and had no significant history of weakness or sensory disturbance. Moreover, her family has not experienced cerebrovascular disease. Right carotid angiogram demonstrated stenosis of the terminal portion of the ICA with moyamoya vessels []. Left carotid angiogram and left vertebral angiogram showed no apparent abnormality [Figure and ]. Single photon emission computed tomography (SPECT) demonstrated hypoperfusion in the right cerebral hemisphere. The response to the acetazolamide was impaired []. She was diagnosed as unilateral MMD and followed by MR imaging annually. During 6 years, she had been intact and MR imaging had not detected progression of MMD. However, 7 years after the diagnosis, cerebral aneurysm appeared in the right basal cistern, probably from anterior choroidal artery, and conventional angiography was planed []. Before that, she become comatose and brought to our hospital emergently. Computed tomography (CT) showed massive intraventricular hemorrhage []. Enlargement of the aneurysm was revealed by CT angiography [Figure –]. Intracerebral hematoma was evacuated and the aneurysm was obliterated by bipolar coagulation. Postoperatively, she was in vegetative state and transferred to the rehabilitation hospital.