title: Moyamoya disease presenting with an acute confusional state in an elderly patient.
abstract: Moyamoya disease is the angiographic diagnosis of a clinical syndrome showing bilateral stenosis or occlusion of the distal internal carotid arteries and their major branches with extensive parenchymal, leptomeningeal, or transdural anastomoses. The clinical features normally present as reversible ischemic neurologic deficits, sensory-motor attacks with acute hemiplegia, and motor convulsion. An acute confusional state (ACS) among hospitalized patients is a frequent and serious problem. It is characterized by an acute neurologic deficit with a fluctuating course of impaired attention span, unorganized thinking, and altered levels of consciousness. We report a case of 66-year-old woman who presented with an ACS in the emergency department. The subsequent workups including a neuroradiological examination revealed a rare case of moyamoya disease with bifrontal ischemic infarction. The recognition of an ACS as a manifestation of moyamoya disease should therefore be included in the differential diagnosis of elderly patients who present with an acutely altered neuropsychiatric state. A prompt diagnosis may help to select the most appropriate therapy for this rare disorder especially in elderly patients.
authors.affiliation: Department of Neurology, Asanogawa General Hospital, Kanazawa City, Ishikawa, Japan. Electronic address: nakanisi@asanogawa-gh.or.jp.
authors.forename: Megumi
authors.initials: M
authors.lastname: Nakanishi
authors.affiliation: Department of Neurology, Kanazawa Medical University, Kahoku, Ishikawa, Japan.
authors.forename: Muichi
authors.initials: M
authors.lastname: Kaito
authors.affiliation: Department of Neurology, Kanazawa Medical University, Kahoku, Ishikawa, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Gondo
authors.affiliation: Department of Neurosurgery, Kanazawa Medical University, Kahoku, Ishikawa, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Takada
authors.affiliation: Department of Neurology, Kanazawa Medical University, Kahoku, Ishikawa, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Matsui
authors.affiliation: Department of Neurology, Asanogawa General Hospital, Kanazawa City, Ishikawa, Japan.
authors.forename: Genjiro
authors.initials: G
authors.lastname: Hirose
mesh_terms: D000368:Aged; D001772:Blood Cell Count; D001774:Blood Chemical Analysis; D001921:Brain / Q000000981:diagnostic imaging; D002339:Carotid Arteries / Q000473:pathology; D002533:Cerebral Angiography; D003221:Confusion / Q000523:psychology*; D006429:Hemiplegia / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009072:Moyamoya Disease / Q000175:diagnosis* / Q000523:psychology*