Patient T.N. P. L (female, 20 years old, residing in Can Tho), was diagnosed with Moyamoya disease. The patient's family said that about 2 years ago, the patient often had prolonged headaches for 15 days/month. At the local hospital, patient L. was diagnosed with dengue fever, 5 days later she began to have facial distortion and left half-body paralysis.
MRI results showed that the patient had Moyamoya disease and was advised to be transferred to Cho Ray Hospital for intensive treatment. "For the past 2 years, the patient has frequently had headaches and dizziness. Although he has been examined and treated in many places, he often mistakenly believes that the symptoms are caused by Basedow's disease being treated, and the cause is not detected from cerebral blood vessel obstruction," the patient's relative said.
After that, patient L. was transferred to Cho Ray Hospital in a conscious state but with severe headache, left facial paralysis, weak left leg, and complete paralysis of the left arm. At the Department of Neurosurgery, the results of MRI of cerebral hemorrhage and DSA of cerebral artery recorded signs of Moyamoya - congenital cerebral vascular obstruction.
This is a progressive cerebrovascular disease characterized by narrowing or gradual obstruction of the ends of the internal carotid artery and large branches in the skull, accompanied by the formation of an abnormal circulatory system. The natural progression of the disease poses a high risk of stroke, cerebral ischemia, or recurrent cerebral hemorrhage, especially in young patients.
In clinical practice, diagnosis is often difficult due to diverse clinical manifestations, easily confused with other neurological and internal medicine diseases, while optimal treatment strategies require close coordination between different specialties. In addition, medical literature records that the rate of cerebral ischemic stroke in patients with Moyamoya symptoms is 17%-33% in 5 years. The rate of secondary stroke in 5 years is 65% (for Moyamoya disease on one side) and 82% (for Moyamoya disease on both sides).
After conducting a consultation and assessing the patient's actual condition, the treatment team decided to perform brain artery bypass surgery inside and outside the skull. However, the special point in this case is that the team used microsurgery glasses with integrated fluorescence function, one of the most modern technologies in neurosurgery pioneered by Cho Ray Hospital nationwide and put into application from mid-2025.
Dr. Tran Minh Tri - Deputy Head of Neurosurgery Department, Cho Ray Hospital said: "In the case of Moyamoya disease with severe cerebral artery stenosis causing symptoms of weakness and paralysis in patients, the most important requirement is surgery to connect cerebral blood vessels inside and outside the skull, in order to regenerate cerebral blood flow in the damaged area, save brain cells that have not been necrotic, improve neurological symptoms and reduce the rate of secondary stroke.
After surgery, the patient began to move his left arm (the paralyzed arm). One day after surgery, the left arm recovered its limb base muscles almost normally, the paralysis of the left face improved, the patient's health stabilized and he was discharged from the hospital 1 week later.
