Moyamoya disease with a marked collateral supply through the artery of Bernasconi-Cassinari.
A case of moyamoya disease is presented. The patient is a 15-year-old white Spanish girl who had the onset of the neurological symptoms at 8 months of age with seizures, transient ischemic attacks and residual left hemiparesis. Cerebral arteriography performed at the age of 1 year revealed all the features of moyamoya disease in the territory of both carotids and in the vertebrobasilar arteries. The presence of an embryonic tentorial artery, the Bernasconi-Cassinari artery, originating from the right internal carotid artery, was disclosed at 1 year of age but did not appear in an arteriogram performed at 6 years of age and it was revisualized by magnetic resonance arteriography (MRA) performed at the age of 15 years. This finding seems to indicate a very early intrauterine onset of the disease in this case and demonstrates the superiority of MRA over conventional arteriography to discover anomalies of intracranial vessels. Administration of nicardipine, a calcium channel blocker, added to conventional antiepileptic drugs that the patient had previously taken, improved the epileptic and the neurological disease.
Service of Pediatric Neurology and Autonoma University, Hospital Infantil 'La Paz', Madrid, Spain.
I
I
Pascual-Castroviejo
J
J
Viano
S I
SI
Pascual-Pascual
A
A
Perez-Higueras
V
V
Martinez
D000293:Adolescent; D000792:Angiography; D001921:Brain / Q000098:blood supply*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology*; D002941:Circle of Willis / Q000473:pathology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed