Moyamoya disease and sagittal sinus thrombosis in a child with Down's syndrome

A girl with Down's syndrome, moyamoya disease and sagittal sinus thrombosis is described. She was diagnosed after acute neurological deterioration by MRI and angiography. Recombinant tissue plasminogen activator (r-TPA) was i njected locally to recanalise the thrombus. The patient's condition signifi cantly improved and she was discharged. After 2 years of followup the child remains asymptomatic. Moyamoya syndrome and cerebral venous thrombosis sho uld not be overlooked as a cause of acute neurological deterioration in a c hild with Down's syndrome. MRA ap pears to be a safe and accurate alternati ve to traditional angiography for the diagnosis of moyamoya disease. Local fibrinolysis with r-TPA is the treatment of choice for cerebral venous thro mbosis due to its safety and efficacy.