title: A case of isolated middle cerebral artery stenosis with hemichorea and moyamoya pattern collateralization.
abstract: Isolated middle cerebral artery (MCA) stenosis in young patients with no other medical condition may be a unique pathologic entity with a benign long-term course. Generally, moyamoya disease shows a progression of stenosis from internal cerebral artery (ICA) to other intracranial vessel. A 26-year-old woman was admitted for choreic movements of the right arm and leg. Brain magnetic resonance imaging showed no stroke. Conventional angiography revealed 48% stenosis of the left M1 without ICA stenosis. Single photon emission computed tomography revealed perfusion asymmetry after acetazolamide injection, suggesting decreased uptake in the left basal ganglia and the cerebral cortex. Her hemichorea was mildly decreased with risperidone. One year later, follow-up angiography showed complete occlusion of the left M1 with neovascularization suggestive of moyamoya disease. The patient underwent bypass surgery and her hemichorea disappeared. This may be an atypical presentation of moyamoya disease. The bypass surgery was an effective measure for restoring the vascular insufficiency and, resultantly, controlling her hemichorea.
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seok Jong
authors.initials: SJ
authors.lastname: Chung
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyung Seok
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Han Soo
authors.initials: HS
authors.lastname: Yoo
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyung Min
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ki Jeong
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Samsung Medical Center, Seoul, Korea.
authors.forename: Jong-Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ilsan Hospital, National Health Insurance Corporation, Seoul, Korea.
authors.forename: Jae-Wook
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Neurology, Ilsan Hospital, National Health Insurance Corporation, Seoul, Korea.
authors.forename: Jong Hun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ilsan Hospital, National Health Insurance Corporation, Seoul, Korea.
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Department of Neurology, Ilsan Hospital, National Health Insurance Corporation, Seoul, Korea.
authors.forename: Gyu Sik
authors.initials: GS
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ilsan Hospital, National Health Insurance Corporation, Seoul, Korea.
authors.forename: Jun Hong
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Neurology, Ilsan Hospital, National Health Insurance Corporation, Seoul, Korea.
authors.forename: Sun-Ah
authors.initials: SA
authors.lastname: Choi
keywords: Hemichorea; Middle cerebral artery stenosis; Moyamoya