Allergic Reaction Induced Brainstem Stroke in a Patient With Moyamoya Disease: A Case Report

Abstract

Moyamoya disease is characterized by progressive peripheral stenosis of the internal carotid artery (ICA) and its proximal branches and can cause both ischemic and hemorrhagic strokes. However, its underlying pathophysiology has not yet been fully elucidated, and this poor knowledge reflects the uncertainty and heterogeneity of patient management. To date, no pharmacological treatment has been found to reverse the gradual loss in the ICA. Antiplatelet agents are commonly prescribed for ischemic moyamoya disease, although the coexistence of bleeding risk should be considered. Allergy-induced anaphylactic reactions can result in vasodilation, hypotension, bronchospasm, and angioedema, and are characterized by a rapid onset of respiratory and circulatory disturbances. This can lead to cerebrovascular collapse; however, such cases are rarely reported. In this case report, an allergic reaction was found A patient who ate peaches and developed urticaria complained of left sided weakness within minutes. Upon admission, the vital signs and breathing pattern became stable without evidence of anaphylaxis. After magnetic resonance imaging evaluation, the patient was diagnosed with acute ischemic stroke in the right pons, and cerebral angiography revealed moyamoya disease. Reports regarding an allergic reaction without anaphylaxis causing a stroke were extremely limited; however, no study has reported that allergy can cause a stroke in patients with moyamoya to date. Therefore, an ischemic stroke may occur in a patient with moyamoya only with an allergic reaction considered and reported as something that should be considered significant in the daily routine and medication for a patient with moyamoya.