We describe the case of a 13-year-old Filipino female with Moyamoya disease presenting as acute unilateral choreiform movements involving the right upper and lower extremities which were involuntary, writhing in character, intermittent, apparent on volition and even at rest, and wanes during sleep. Ancillary history was noncontributory with no history of transient ischemic attacks or headache, no recent intake of medications or infection. Cranial magnetic resonance imaging revealed chronic infarcts in the bilateral frontal lobes and in the body of the right caudate which is ipsilateral to the choreiform movement while the magnetic resonance angiography showed narrowing of the bilateral internal carotid arteries with collateral vessel formation consistent with Moyamoya disease. A video electroencephalogram showed normal interictal EEG in wakefulness, drowsiness, and sleep without epileptiform activity nor focal abnormality. Events seen as right wrist dorsiflexion followed by right arm extension did not have any ictal correlates. Clonazepam aided in the resolution of the involuntary movement after 1 week of intake. To the best of our knowledge, this is the first report of Moyamoya disease in a Filipino adolescent presenting as movement disorder.

Sally Andrea Gaspi
Philippine General Hospital
Philippines

Patricia Orduña
Philippine General Hospital
Philippines

Marilyn Tan
Philippine General Hospital
Philippines