title: Pial Synangiosis Ameliorates Movement Disorders in the Absence of Prior Stroke in Moyamoya Disease.
abstract: BACKGROUND
  Moyamoya disease is a rare cerebrovascular disease characterized by progressive stenosis of the bilateral distal internal carotid arteries and their proximal branches. Both chorea and dystonia have been reported as the initial presentation of moyamoya disease.
  
  
  OBJECTIVE
  The objective was to define the clinical presentation and describe the disease course following pial synangiosis of 3 patients with dyskinesias.
  
  
  METHODS
  A retrospective chart review of 3 cases of patients presenting with movement disorders and ultimately diagnosed with moyamoya disease was performed.
  
  
  RESULTS
  The authors present a case series of 1 patient with dystonia and 2 patients with chorea, all diagnosed with moyamoya disease. All patients experienced resolution of their movement disorders following pial synangiosis. Magnetic resonance imaging disclosed moyamoya disease-related basal ganglia anomalies in all patients.
  
  
  CONCLUSIONS
  Moyamoya disease is an important and surgically treatable cause of movement disorders.
authors.affiliation: Department of Neurological Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical School, Pittsburgh PA, USA stephanie.greene@chp.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Greene
authors.affiliation: Department of Neurology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical School, Pittsburgh PA, USA.
authors.forename: Lalit
authors.initials: L
authors.lastname: Bansal
authors.affiliation: Department of Neurology, Children's Mercy Hospital, Kansas City, MO, USA.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Coffman
authors.affiliation: Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Nardone
authors.affiliation: Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical School, Pittsburgh PA, USA.
authors.forename: Giulio
authors.initials: G
authors.lastname: Zuccoli
mesh_terms: D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D009069:Movement Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D009072:Moyamoya Disease / Q000150:complications*; D010841:Pia Mater / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000209:etiology*
keywords: chorea; dystonia; indirect bypass; movement disorder; moyamoya; pediatric; pial synangiosis