13-4 Usefulness of carotid duplex ultrasonography in a patient with Moyamoya disease

We report a 35-year-old man with transient disturbance of consciousness and left hemiplegia just after evacuation. At first, we thought that he had epilepsy with Todd's palsy. An electroencephalogram and hematologic studies were immediately performd, but no abnormality was detected. However, carotid ultrasonography showed an increase in end-diastolic flow velocity and a decrease in vascular resistance in both external carotid arteries. These findings indicated that there was arteriovenous malformation such as moyamoya desease. Brain magnetic resonance imaging showed spotty high signal lesions in the subcortical areas. and the middle cerebral artery was not visualized on magnetic resonance angiography (MRA). Cerebral angiography demonstrated moyamoya vessels in the brain and collateral circulation from the external carotid artery. Therefore, we diagnosed him as haviug moyamoya disease. Duplex ultrasonography of the common and, internal carotid, and vertebral arteries is a widely-used technique. Recently, cerebral angiography, MRA and transcranial Doppler have been applied to detect intracranial ascular malformation. But our results suggested that moyamoya disease can be detected by means of carotid duplex ultrasonography. Finally, we considered that carotid nltrasonography is not only a noninvasive screening method but also a useful for the diagnosis of moyamoya disease.