One sided bypass for bilateral Moyamoya disease, a case report and review of the literatures

• Moyamoya disease (MMD) is a rare condition which can present both in children and adults.
• Diagnosis is usually established after imagine.
• Treatment is aiming at stroke prevention by improving blood flow.
• When surgical intervention is considered, unilateral revascularisation might be sufficient even for patients with bilateral lesion.

BackgroundMoyamoya disease (MMD) is a rare condition, where the most appropriate treatment for it is yet to be determined. Surgery remains an important method of choice although it is considered a form of palliative care. The outcome following surgery is very difficult to judge, and there is no standardised measurement to assess it. It is therefore important to know which approach for such patient is adequate.Clinical presentationA 21-year-old male patient presented with signs and symptoms of intracranial haemorrhage. Upon investigation, a diagnosis of bilateral MMD was made, and one sided direct bypass surgery was subsequently performed. At 3-year follow-up, there is no evidence of recurrent cerebral vascular event.ConclusionThis case provided further evidence that direct bypass surgery is beneficial for patient in terms of blood flow improvement and symptom relieve. Although there is no consensus on whether bilateral surgical intervention is mandatory for patient with bilateral MMD, unilateral bypass might be sufficient enough. Further study is required to evaluate the best approach for such group of patient.