Kim et al outlined their diagnostic strategy for adult moyamoya disease (MMD) using a flow diagram. The authors are from Seoul National University Hospital.


Criteria for adult moyamoya disease:

(1) age >= 18 years

(2) angiographic appearance for unilateral or bilateral moyamoya disease

(3) one of the following:

(3a) family history of MMD

(3b) exclusion of conditions that may mimic moyamoya disease


Conditions to exclude for the diagnosis of moyamoya disease:

(1) diabetes mellitus

(2) history of head trauma

(3) history of cranial radiation

(4) intracranial infection

(5) history of other prothrombotic event

(6) >= 3 risk factors for atherosclerosis (heavy smoking, hypertension, dyslipidemia, heavy drinking)

(7) congenital anomaly that may mimic MMD (fibromuscular dysplasia, Marfan syndrome, tuberous sclerosis, polycystic kidney disease)



• Diabetes mellitus would be a risk factor for atherosclerosis.

• Heavy drinking may be a risk factor for head trauma. Often heavy drinkers have relatively clean arteries.


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