Moyamoya syndrome in a child with HbEβ-thalassemia

Orofacial features and dental management of a pediatric patient with moyamoya disease-A one year follow up

Key Clinical Message

Moyamoya disease (MMD) is a chronic cerebrovascular disorder increasing stroke risk. This study presents a four-year-old MMD patient, discussing her multidisciplinary care plan including dental, behavioral, and medical management. It emphasizes the need for awareness among oral physicians and suggests further research due to the rising prevalence of MMD.

Abstract

Moyamoya disease (MMD) is a chronic cerebrovascular disorder that narrows major blood vessels in the brain, reduces blood flow, and increases the risk of stroke. The purposes of this study were to: (1) present the case of a four-year-old patient diagnosed with MMD; (2) discuss important aspects of her multidisciplinary care plan involving dental, behavioral, and medical management; and (3) suggest approaches and recommendations for health care providers. A four-year-old Middle Eastern female diagnosed with MMD, neurogenic bladder, chronic constipation, hyperactivity, and delayed milestones presented to the dental clinic with her parents seeking dental care. The child was referred by a pediatric neurologist for dental care. In the present case, there were no specific oral manifestations. However, oral physicians should be aware of possible behavioral management modalities when providing dental care to pediatric patients, including those diagnosed with MMD.

Beta-Thalassemia Presenting as Moyamoya Syndrome With a Review of Skeletal Manifestations

Moyamoya angiopathy (MMA) is a progressive vasculopathy characterized by slowly progressive stenosis involving the proximal portions of the major intracranial arteries, resulting in strokes and intracranial hemorrhages. If it occurs secondary to a known cause, it is called Moyamoya syndrome (MMS). Here, we describe the case of a five-year-old male child who presented to us with symptoms of stroke and, upon evaluation, revealed Moyamoya angiopathy. He was further evaluated, and it was found that MMA occurred as a complication of undetected beta-thalassemia. Thalassemia is an autosomal recessive blood disorder where there is a defect in hemoglobin production. It affects 100 to 150 thousand children in the Indian subcontinent. It is classified into two main types: alpha thalassemia and beta thalassemia, depending on which globin chain is affected. It primarily presents with symptoms of anemia such as easy fatiguability, dizziness, jaundice, or breathlessness. The occurrence of Moyamoya syndrome in beta-thalassemia is extremely rare, and it is extremely important to identify MMS at the earliest as it can cause long-term disabilities. We describe the imaging findings in MMS and the various classical skeletal radiographic findings in thalassemia that were seen in our patient.

Moyamoya syndrome with ruptured aneurysm in α‑thalassemia: A case report

Moyamoya syndrome (MMS) refers to the moyamoya vascular disease associated with various systemic diseases and conditions, including sickle cell anemia, Fanconi anemia and iron deficiency anemia. However, the association between MMS and other hemoglobinopathies is less frequently observed. MMS, like moyamoya disease, is a cerebrovascular condition that is characterized by chronic progressive stenosis or occlusion at the ends of the bilateral internal carotid arteries, anterior cerebral arteries and the beginning of the middle cerebral arteries, and is secondary to the formation of an abnormal vascular network at the base of the skull. Patients with MMS are prone to thrombosis, aneurysm and bleeding. The present study reports the case of a 43-year-old man with α-thalassemia who presented with moyamoya vessels with a ruptured aneurysm bleeding into the ventricle. α-thalassemia is considered as an extremely rare but potential cause of MMS. Since MMS is a progressive disease, early diagnosis and treatment is vital to prevent the disease from worsening.