We present the clinical, radiological and autopsy findings in a 32-yea
r-old woman with primary oxalosis, who suffered recurrent bilateral ca
rotid territory infarcts. The overall features were those of moya-moya
syndrome, with bilateral, ultimately thrombotic, occlusion of the dis
tal internal carotid arteries. Vessel pathology suggests an underlying
intimal vasculopathy, the possible relation of which to the patient's
metabolic abnormality is discussed.