title: Involuntary movement in pediatric moyamoya disease patients: consideration of pathogenetic mechanism using neuroimaging studies.
abstract: OBJECTIVE
  Involuntary movement is a rare symptom of moyamoya disease (MMD). No consensus has been reached regarding its clinical features and pathogenetic mechanism. Therefore, pediatric MMD patients presenting with involuntary movement were retrospectively analyzed, focusing on the image findings.
  
  
  METHODS
  A total of 513 patients who were treated for MMD were reviewed. After exclusion of MMD syndromes and those with accompanying conditions related to involuntary movements, five patients (mean age: 11.6 years, range: 5-13 years) were evaluated.
  
  
  RESULTS
  All of the patients improved their symptoms rapidly after the indirect bypass operations to the contralateral hemisphere. All remained symptom-free during the long follow-up period. Comprehensive evaluation of the preoperative imaging findings failed to suggest a characteristic feature in common, corresponding to the existing hypotheses or a new hypothesis. Only one patient showed infarction preoperatively, and only one patient showed prominently enhanced collateral vessels in the basal ganglia. Although a decrease in vascular reserve was observed in all patients, the location and laterality were nonspecific.
  
  
  CONCLUSIONS
  There still appears to be confusion regarding the pathogenetic mechanism of involuntary movement in MMD with no repetitive, established imaging features to explain the phenomenon. Nonetheless, with its excellent response to surgical treatment, clinical awareness of this rare symptom of MMD should be emphasized as a differential diagnosis for secondary movement disorder in children.
authors: Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors: Ji Yeoun
authors: JY
authors: Lee
authors: Seung-Ki
authors: SK
authors: Kim
authors: Kyu-Chang
authors: KC
authors: Wang
authors: Jong Hee
authors: JH
authors: Chae
authors: Jung-Eun
authors: JE
authors: Cheon
authors: Jung Won
authors: JW
authors: Choi
authors: Ji Hoon
authors: JH
authors: Phi
authors: Byung Chan
authors: BC
authors: Lim
authors: Ki Joong
authors: KJ
authors: Kim
authors: In-One
authors: IO
authors: Kim
authors: Yong Seung
authors: YS
authors: Hwang
authors: Young Seob
authors: YS
authors: Chung
mesh_terms: D000293:Adolescent; D002548:Cerebral Revascularization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009069:Movement Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D009072:Moyamoya Disease / Q000150:complications* / Q000601:surgery; D059906:Neuroimaging / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis