Unexpectedly Disabling Headache Revealing Moyamoya Disease in a Child in Sub-Saharan Africa: A Case Report and Review of the Literature.

Abstract Introduction Moyamoya disease is a chronic cerebral vasculopathy of unknown origin. It is rarely described in Africa, especially in sub-Saharan Africa. Stroke is the major clinical manifestation. Headache, on the other hand, is a rare presenting symptom, especially when it is recent and disabling. Here, we report a case of moyamoya disease in a child in sub-Saharan Africa that was unexpectedly diagnosed by recent disabling headaches. Case presentation A 9-year-old male child with a two-week history of disabling headaches was admitted to the neurology department. These headaches were associated with vomiting, without fever, seizures or loss of consciousness, and without signs of localization. The cranioencephalic CT scan performed on the day of admission was normal. Twenty-four hours later, a left hemicorporeal motor deficit and visual disturbances appeared. Cerebral MRI and TOF angio-MRI revealed bilateral infarcts in the territories of the right middle cerebral artery and posterior cerebral arteries, with stenosis of both ends of the distal internal carotid arteries, giving a "smoke cloud" appearance to the cerebral vessels, suggestive of moya moya disease. The results of secondary etiology studies were unremarkable. Conclusions This case report alerts practitioners to an unusual initial clinical presentation of moyamoya disease in children and prompts them to prescribe cerebral MRI coupled with cerebral angio-MRI in the presence of an inaugural, disabling headache. This case also adds to the sub-Saharan literature on this disease.