Rehana Shaikh, Saba Sohail, Aiman Ashraf, Din Muhammad


A 2-year old girl referred to our department with complaint of transient ischemic attack and right sided hemiparesis, was investigated with contrast enhanced MRI Brain and time of flight MRA and diagnosed as moyamoya disease with ivy sign. The ivy sign is a Magnetic resonance imaging (MRI) finding observed both in post contrast T1-weighted images (T1WI) and Fluid attenuated inversion recovery (FLAIR) images due to the development of leptomeningeal collateral and pial network. Moyamoya disease is a progressive multifocal occlusive arteriopathy of unknown origin and is an infrequent cause of cerebrovascular accident in children. The patient was treated conservatively and referred to a higher centre for specific neurosurgical revascularization surgery which has favorable outcome but because of his family disagreement cerebral revascularization surgery was not performed.

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