Multiple sclerosis and Moyamoya angiopathy: Mimic and misdiagnosis

Shambaditya Das; Biman Kanti Ray; Alak Pandit; Swati Kumar; Souvik Dubey

doi:10.1016/j.msard.2022.104036

Multiple sclerosis and Moyamoya angiopathy: Mimic and misdiagnosis

Mult Scler Relat Disord. 2022 Oct:66:104036. doi: 10.1016/j.msard.2022.104036. Epub 2022 Jul 5.

Authors

Shambaditya Das¹, Biman Kanti Ray¹, Alak Pandit¹, Swati Kumar¹, Souvik Dubey²

Affiliations

¹ Department of Neurology, Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India.
² Department of Neurology, Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India. Electronic address: drsouvik79@gmail.com.

PMID: 35858500
DOI: 10.1016/j.msard.2022.104036

Abstract

Moyamoya Angiopathy (MMA) is frequently not considered in differential diagnosis of Multiple Sclerosis (MS). This is the first study to prospectively analyze rate of misdiagnosis of MMA as MS and its clinical implications. Of the 160 angiographically proven MMA, 5 patients had an initial misdiagnosis of MS (3.13%). These 5 cases had female-predominance (80%).Out of the 5 cases, 4 cases (80%) presented with hemiparesis; 3 cases (60%) had an immediate precipitating factor. Radiologically, presence of both periventricular and juxtacortical white-matter-lesions was seen in 4 out of 5 cases (80%);none had infratentorial/spinal lesion, while all 5 cases had presence of "Ivy" sign and abnormal flow voids. Differentiation relies on careful evaluation of clinico-radiological features. MMA should be considered as a rare but important differential to MS.

Keywords: Mimic; Moyamoya angiopathy; Moyamoya disease; Multiple sclerosis.

Publication types

Letter

MeSH terms

Diagnostic Errors
Female
Humans
Magnetic Resonance Imaging
Moyamoya Disease* / diagnostic imaging
Multiple Sclerosis* / diagnostic imaging
Multiple Sclerosis* / pathology