Moyamoya syndrome is a rare, progressive cerebrovascular disorder characterized by bilateral stenosis or occlusion at the terminal segments of the internal carotid arteries (ICAs) and their proximal branches. Secondary moyamoya following tuberculous meningitis (TBM) is uncommon, particularly in children. A 3‐year‐old girl with a history of TBM presented with progressive left‐sided spastic hemiplegia, seizures, and developmental regression. Despite initial management for hydrocephalus and seizures, persistent neurological decline prompted further evaluation. Magnetic resonance angiography (MRA) revealed bilateral supraclinoid ICA stenosis with basal collaterals, consistent with secondary moyamoya syndrome. Conservative management included antitubercular therapy (ATT), antiepileptics, antiplatelets, and a multidisciplinary neurorehabilitation program. Over a 12‐month follow‐up, the child demonstrated measurable improvements in motor function (Modified Ashworth Scale MAS from Grade 3 to Grade 1), developmental age across gross motor, fine motor, and language domains, oral‐motor function, feeding efficiency, and nutritional status. Follow‐up magnetic resonance imaging (MRI)/MRA showed stable vascular findings without new infarcts. This case emphasizes the importance of distinguishing moyamoya syndrome from static motor disorders such as cerebral palsy in children with prior CNS infections. Early diagnosis, regular developmental monitoring, and individualized multidisciplinary care are crucial for optimizing outcomes. Conservative management may be effective in stable presentations, reducing the need for immediate surgical intervention.
Mohammed et al. (Thu,) studied this question.