When MRI Is Not Enough: Moyamoya Disease Presenting with Recurrent Transient Ischaemic Attacks and Seizures in a 12-Year-Old Boy from Western India

This record contains an archived pediatric clinical case report of moyamoya disease originally prepared in 2017 and shared for educational and open-science purposes. The case describes a 12-year-old child who presented with recurrent transient ischemic attacks and seizure-like episodes in whom conventional brain magnetic resonance imaging was inconclusive, while magnetic resonance angiography demonstrated bilateral supraclinoid internal carotid artery stenosis with characteristic collateral vessel formation, establishing the diagnosis. The report highlights an important diagnostic pitfall in pediatric cerebrovascular disease and emphasizes the need for early vascular imaging when clinical suspicion persists despite non-diagnostic first-line investigations. Although diagnostic criteria and understanding of the disease have evolved since the case was prepared, delayed recognition of moyamoya disease remains common in real-world practice, particularly in low- and middle-income settings. Written informed consent was obtained at the time of original case preparation, all patient identifiers have been removed, and no new data or analyses are presented in this archived educational report.