title: A Case of Moyamoya Disease with a Transient Neurologic Deterioration Associated with Subcortical Low Intensity on Fluid-Attenuated Inversion Recovery Magnetic Resonance Images After Bypass Surgery.
abstract: BACKGROUND
  Moyamoya disease often is treated by revascularization surgery. In this report, we are the first to describe a case of moyamoya disease that repeatedly showed a transient subcortical low intensity (SCLI) on fluid-attenuated inversion recovery (FLAIR) magnetic resonance images postoperatively.
  
  
  METHODS
  A 59-year-old woman presenting with repeated transient ischemia underwent right superficial temporal artery to middle cerebral artery anastomosis with encephalo-duro-myo-synangiosis. After the operation, the patient had a transient neurologic deterioration. Findings on magnetic resonance imaging were not particular apart from SCLI and sulcal hyperintensity on FLAIR images, but no abnormalities in cerebral blood flow on single-photon emission computed tomography with N-isopropyl [123I]-p-iodoamphetamine and no abnormalities on electroencephalogram were found. Symptoms improved in a few days, and SCLI on FLAIR images disappeared in a few months. Thereafter, when the left-sided bypass surgery was performed, similar findings occurred in the left cerebral hemisphere.
  
  
  CONCLUSIONS
  The mechanisms of transient SCLI on FLAIR images remain unclear, but this finding appears to be associated with a postoperative transient neurologic deterioration.
authors.affiliation: Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan. Electronic address: satoru-tanioka@umin.net.
authors.forename: Satoru
authors.initials: S
authors.lastname: Tanioka
authors.affiliation: Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Shiba
authors.affiliation: Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Umeda
authors.affiliation: Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Sano
authors.affiliation: Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Maeda
authors.affiliation: Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D009422:Nervous System Diseases / Q000209:etiology / Q000473:pathology* / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Fluid-attenuated inversion recovery image; Moyamoya disease; Revascularization surgery; Subcortical low intensity