Angiographic Findings of Moyamoya Vessels in a Patient with Rheumatoid Arthritis

and subcortical multiple ischemic lesions. Conventional angiography (CA) showed occlusion of the right internal carotid artery (ICA) in the terminal portion and stenosis of the proximal right ICA with occlusion of the proximal portion of the right middle cerebral artery. Moreover, the patient suffered from symmetrical aching and shoulder, knee and hand stiffness responsive to low-dose corticosteroid therapy (prednisone 25 mg per day). ESR was 117, reactive C protein (RCP) 10.5 mg/dl and rheumatoid factor 650 UI/l. High ESR, RCP and rheumatoid factor values were present before ischemic events and confi rmed during follow-up. Search for other infl ammatory and immunitary parameters was negative as well as antiphospholipid antibodies. Nineteen months later, after new ischemic events involving the left occipital cortex with persistent right lateral homonymous hemianopia, a second cerebral CA was performed. CA demonstrated occlusion of the left cerebral posterior artery, right ICA terminal portion tight stenosis, left ICA proximal tract irregular profi les and occlusion of the same vessel in the terminal portion with newly developed moyamoya vessels prevalent in the left basal area where they appeared in the shape of smoke spirals ( fi g. 1 ). Prednisone was increased (75 mg per day) and anticoagulation was continued. After 6 months of follow-up the patient remained asymptomatic. This is the fi rst report in the literature of a patient with moyamoya vessels associated with RA. Cerebrovasc Dis 2005;20:415–416 DOI: 10.1159/000088666