Moyamoya Disease

Moyamoya Disease: progressive occulsive disease of the cerbral vasculature with particular involvement of the Circle of Willis and the arteries that feed it. Moyamoya is Japansese for a puff of smoke. Moyamoya disease is characterized by intimal thickening in the walls of the terminal portions of the internal carotid vessels bilaterally. The orgin of Moyamoya is unknown. Moyamoya can be hereditary and multifactorial. This disease has the highest rate in Japan and occurs in 10% of adults and 4.3% in children. Moyamoya ranges from the ages of 6 months to 67 years.

Causes: thrombosis, cerebral ischemia, transient ischemic attacks, and athersclerosis.

Symptoms: stroke, recurring transient ischemic attacks, hemiparasis, seizures, disturbed consciousness, speech deficits, sensory impairments, cognitive impairments, involuntary movements and vision problems.

Tests: Cerebral angiography is done to diagnose Moyamoya disease.

Treatment: anticoagulats (Heparin and Coumadin), antiplatelet agents, aspirin, and omental transplantation.



Figure 2a. Moyamoya disease in a 9-year-old boy. (a) Right internal carotid arteriogram in lateral projection shows the right ICA (curved arrow) is occluded, and thus the anterior cerebral and middle cerebral arteries are occluded.

Nasal Polyps

Nasal Polyps: sac-like growths of inflamed tissue lining the nose (nasal mucosa) or sinuses.

Nasal polyps usually begin in the ethmoid sinuses and will eventually grow into open areas. Large polyps can block sinuses and or nasal airway. People with nasal polpys will complain of having a cold that has lasted for months or years.

Causes: aspirin sensitivity (wheezing), asthma, chronic sinus infections, cystic fibrosis, and hay fever.

Symptoms: mouth breathing, nose feeling blocked, reduced or total loss of smell, and runny nose.

Test: CT scan is performed and if positive for nasal polyps they will show up cloudy where the polyps are located.

Treatment: medications can be given, but usually do not get rid of the polyps, but they will help with the symptoms, nasal steriod sprays, Corticosteroid pills or liquid, antibiotics, and some people will require surgery. With removing the polyps from surgery it usually makes it easier to breath through the nose, but overtime the polyps will return.

Complications: bleeding and infection.

Axial (left) and coronal (right) view of CT imaging of the face demonstrating multiple nasal polyps (arrows)

 that appear to have originated from both the lateral wall and the ethmoid process.  The patient who has had

prior nasal polypectomy presented with chronic sinusitis, nasal obstruction and mild headache. 

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