Objective: To describe hemidystonia and hemichoreo-athetosis in an adult pa
tient with; moyamoya disease without a previous history of cerebrovascular
accident.
Design: Case report.
Setting: Tertiary care center. Patient: A 22-year-old woman suddenly develo
ped dystonic spasms in her left hand and left foot after a severe emotional
stress. The dyskinesia gradually subsided over the next 4 months. Five mon
ths after the onset, she suddenly developed choreoathetoid movement in her
right hand and right foot.
Main Outcome and Results: The patient had both somatic and cortical sensory
deficits in the right hand and right foot, Magnetic resonance imaging of t
he brain showed an infarction at the right putamen and lesions involving th
e right frontal lobe and the left frontotemporoparietal lobe. Magnetic reso
nance cerebral angiography showed severe stenoses of both internal carotid
arteries at the supraclinoid portion and numerous collateral vessels, compa
tible with moyamoya disease. Single photon emission tomography of the brain
showed hypoperfused areas at the right frontal and left frontotemporoparie
tal lobes. The choreoathetosis of the right limbs improved markedly, along
with improvement of sensory deficits.
Conclusions: To our knowledge, this is the first report of an adult patient
presenting with hemidystonia and hemichoreoathetosis as the initial manife
stations of moyamoya disease.