Moyamoya disease in an extremely old patient

Purpose: The oldest patients diagnosed with moyamoya disease (MMD) in the USA may have been as oldas 85+ years, and 68 years in Taiwan; therefore, MMD is generally thought not to occur in extremelyold patients in Taiwan. Herein, we report this case to revise the common thinking. Case Report: An 82-year-old woman had suffered twice from a right cerebral infarction. A digital subtraction angiogram demonstrated abundant collateral arterial networks from the bilateral proximal middlecerebral arteries despite the absence of arteriosclerotic stenosis of the bilateral extracranial internalcarotid arteries. Aspirin has effectively controlled her symptom since diagnosis and, as a result, a director indirect revascularization procedure is unnecessary. Conclusion: MMD does occur in extremely old Taiwanese, as old as over 80 years old, and thus should bea differential diagnosis of cerebral infarction in an extremely old patient. Digital subtraction angiogra-phy is the gold standard for the diagnosis.