Atypical Presentation of Moyamoya Disease Presenting With Severe Headache: A Case Report.

Moyamoya disease (MMD) is a rare and progressive cerebrovascular disorder characterized by the stenosis or occlusion of the terminal portions of the internal carotid arteries, accompanied by the formation of a compensatory network of abnormal collateral vessels at the base of the brain. The disease commonly presents with transient ischemic attacks (TIAs), ischemic and hemorrhagic strokes, seizures, cognitive impairments, and headaches. While most cases manifest in childhood or early adulthood, atypical or delayed presentations have been reported. We present the case of a 56-year-old Caucasian male with a history of coronary artery disease, diabetes mellitus, and hypertension who presented with sudden-onset severe right-sided headache, left-sided numbness, and chest pain. Imaging revealed a right middle cerebral artery occlusion, consistent with MMD. The patient was managed with antiplatelet therapy and close monitoring, leading to significant improvement in symptoms. This case highlights the importance of considering MMD in patients presenting with persistent headaches and cerebrovascular symptoms and emphasizes the role of antiplatelet therapy in managing cases with preserved cerebral blood flow.