title: 'Smoke in the air': a rare cerebrovascular cause of neurological signs and symptoms in a young adult.
abstract: Moyamoya disease is a rare neurological condition that affects children and adults of all ages. It is characterized by chronic, progressive stenosis of the circle of Willis that ultimately leads to the development of extensive collateral vessels. Presenting symptoms are usually due to cerebral ischemia or hemorrhage. The Japanese term moyamoya (meaning puffy or obscure) was coined to describe the characteristic 'smoke in the air' appearance of these vessels on cerebral angiography. Moyamoya has the highest recorded incidence in Japan (0.28 per 100,000). In the west it is an extremely rare condition with an overall incidence of (0.086 per 100,000) in the Western United States. Etiology for the most part is unknown; however, genetic susceptibility related to RNF213 gene on chromosome 17q25.3 has been suggested. Moyamoya is being diagnosed more frequently in all races with varying clinical manifestations. Moyamoya disease is a rare progressive neurologic condition characterized by occlusion of the cerebral circulation with extensive collaterals recruitment in children and adults. Distinguished radiological findings confirm the diagnosis. Early recognition and swift institution of therapy is vital in order to minimize neurological deficits. We present the case of a 19-year-old African American female who presented with left-sided parastheia, weakness, and headache for 2 days duration.
authors.affiliation: Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA; imtuismail@gmail.com.
authors.forename: Imtiaz
authors.initials: I
authors.lastname: Ismail
authors.affiliation: Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Khafaji
authors.affiliation: Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Mutyala
authors.affiliation: Department of Cardiology, Creighton University, Omaha, NE, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA.
authors.forename: Nawfal
authors.initials: N
authors.lastname: Al-Khafaji
authors.affiliation: Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Kovacs
authors.affiliation: Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
authors.affiliation: Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
keywords: Japanese; Moyamoya; circle of Willis; collaterals; neurology; smoke