ArticleClinical case reports2026
How Far Can we Go? Managing Moyamoya Syndrome in a 3-Year-Old With Thalassemia Major: A Rare Pediatric Case From Nepal.
Article in Clinical case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Moyamoya syndrome (MMS) is a rare progressive cerebrovascular disorder causing stenosis of intracranial arteries and collateral vessel formation. Pediatric presentations often include ischemic strokes, and coexisting Thalassemia Major may worsen vascular outcomes. A 3-year-old male with Thalassemia Major presented with acute right-sided weakness, altered consciousness, and a prior left-sided stroke. Examination revealed facial asymmetry, aphasia, and right-sided hemiparesis. Laboratory tests excluded metabolic, infectious, and cardio-embolic causes. MRI Brain with contrast and TOF-MRA demonstrated chronic right-sided changes, acute left-sided ischemia, and marked narrowing of the supraclinoid and cavernous segments of the left internal carotid artery, confirming Moyamoya disease, Suzuki stage 3. The patient received aspirin (3 mg/kg/day) and supportive care. After 5 days, neurological status improved (GCS 14, right limb power 3/5). Surgical revascularization via EDAS was advised but deferred due to financial constraints. This case highlights alternating hemiparesis as a rare pediatric MMS presentation, the diagnostic utility of MRI/MRA, and the impact of socio-economic limitations on access to definitive surgical care.
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