Objective: The aim of this study is to describe a rare cause of parkinsonism.

Background: Moyamoya disease (MMD), a rare chronic, progressive cerebrovascular disease leads to occlusion of intracranial internal carotid arteries and its proximal branches. Movement disorders, as for parkinsonism, are rarely revealing this pathology.  

Methods: We report a case of a 51-year-old female, who presented a tremor localized in her left arm.

Results: Clinical examination showed unilateral extrapyramidal syndrome. In the CT scan, we found a thalamic hematoma and intraventricular hemorrhage. She was diagnosed MMD based on the angiography demonstrating bilateral intracranial internal carotid artery stenosis with puff of smoke appearance. She did not consent for revascularization procedure and she had only medical treatment.

Conclusions: MMD is commonly associated with cerebral Hemorrhages in adults. Intracerebral hematoma is the most frequently in the basal ganglia region. Thalamic bleed is relatively uncommon and found in about 21.4% patients. Clinical manifestations are usually hemiparesis. Movement disorders and especially parkinsonism as revealing symptom are very rare. To our knowledge only 8 patients had movement disorder in this context due to anatomical or functional lesions in basal ganglia. Movement disorders are rarely associated with hemorrhagic stroke as well as with MMD. In front parkinsonism, angio-MRI is mandatory to not misdiagnose this disease. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsonism-revealing-cerebral-hematoma-with-moya-moya-disease/