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- Title
Neurovascular considerations in patients with Down syndrome and moyamoya syndrome.
- Authors
Abramyan, Arevik; Fu, Allen Ye; Patel, Khushi; Sun, Hai; Roychowdhury, Sudipta; Gupta, Gaurav
- Abstract
In this article, we describe a rare and complex case of moyamoya syndrome in a 7-year-old boy with Down syndrome and atlantoaxial subluxation. The patient presented with an ischemic stroke in the left hemisphere and cervical cord compression with increased cord edema. Diagnostic digital subtraction angiography revealed unique patterns of vascular involvement, with retrograde flow through the anterior spinal artery, ascending cervical artery, occipital artery, and multiple leptomeningeal arteries compensating for bilateral vertebral artery occlusion. This case underscores the underreported phenomenon of upward retrograde flow through the anterior spinal artery in bilateral vertebral artery occlusion. We address the rare manifestation of posterior circulation involvement in moyamoya syndrome, highlighting the importance of considering atlantoaxial instability as a contributing factor, as the absence of atlantoaxial stability is a risk factor for vertebral artery dissection. This study contributes valuable insights into the intricate relationship of moyamoya syndrome, Down syndrome, and atlantoaxial instability, urging clinicians to consider multifaceted approaches in diagnosis and treatment. It also emphasizes the potential significance of the anterior spinal artery as a compensatory pathway in complex vascular scenarios.
- Subjects
PEOPLE with Down syndrome; VERTEBRAL artery; DIGITAL subtraction angiography; VERTEBRAL artery dissections; SUBLUXATION; ARTERIAL occlusions; CERVICAL cord
- Publication
Child's Nervous System, 2024, Vol 40, Issue 5, p1617
- ISSN
0256-7040
- Publication type
Case Study
- DOI
10.1007/s00381-024-06293-z