title: Diagnosing moyamoya syndrome using ultrasound - a case report.
abstract: BACKGROUND
  Moyamoya syndrome is a vasculopathy characterised by progressive occlusion of the cerebral arteries resulting in the development of abnormal collateral circulation. To diagnose this syndrome, imaging of the cerebral arteries is required including CT- or MR-angiography and conventional angiography. We present a case of moyamoya disease with typical findings detected in the sonography. The diagnosis was suspected after reviewing the initial ultrasound images of the cerebral arteries with evidence for obliterated intracranial arteries and the detection of an existing collateral circulation network.
  
  
  METHODS
  A 62 years old male patient presented in the hospital's emergency department with symptoms indicating a subacute cerebrovascular event. Immediate sonographic studies showed a right-sided pulsatile Doppler-signal in the common and internal carotid arteries, suggestive of distal stenoses. In addition, the transcranial examination indicated obliteration of both middle cerebral arteries. Numerous arterial vessels suggestive of leptomeningeal collateral arteries revealed a strong arterial leptomeningeal flow. At this stage of the diagnostic work-up, the collateral circulation network, characteristic of moyamoya disease, was indicated by sonography. Moyamoya syndrome was verified by conventional angiography. The aetiological work remained empty, so the diagnosis of moyamoya disease was established.
  
  
  CONCLUSIONS
  Our case report indicates that sonography can be a useful tool for detecting the vaculopathy in moyamoya syndrome. In case routine procedures, such as the CT- or MR-angiography, with evidence for obliterated intracerebral arteries, ultrasound studies might provide important information regarding an existing collateral network in the scope of a moyamoya syndrome.
authors.affiliation: Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany. Tobias.Braun@neuro.med.uni-giessen.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Braun
authors.affiliation: Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany. Martin.Juenemann@neuro.med.uni-giessen.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Juenemann
authors.affiliation: Department of Cardiology and Angiology, Justus Liebig University, Giessen, Germany. Dursun.Guenduez@med.uni-giessen.de.
authors.forename: Dursun
authors.initials: D
authors.lastname: Gündüz
authors.affiliation: Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany. Stefanie.Schmetsdorf@neuro.med.uni-giessen.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schmetsdorf
authors.affiliation: Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany. Florian.Roessler@neuro.med.uni-giessen.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Roessler
authors.affiliation: Department of Neuroradiology, Justus Liebig University, Giessen, Germany. Astrid.E.Grams@radiol.med.uni-giessen.de.|Department of Neuroradiology, University Innsbruck, Innsbruck, Germany. Astrid.E.Grams@radiol.med.uni-giessen.de.
authors.forename: Astrid
authors.initials: A
authors.lastname: Grams
authors.affiliation: Department of Neuroradiology, Justus Liebig University, Giessen, Germany. Carolin.Gramsch@radiol.med.uni-giessen.de.
authors.forename: Carolin
authors.initials: C
authors.lastname: Gramsch
authors.affiliation: Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany. christian.tanislav@neuro.med.uni-giessen.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Tanislav
mesh_terms: D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D009072:Moyamoya Disease / Q000000981:diagnostic imaging*; D018617:Ultrasonography, Doppler, Pulsed