Magnetic Resonance Imaging in Moyamoya Disease

To the Editor. —I wish to congratulate Bruno and colleagues 1 on their excellent study of magnetic resonance imaging (MRI) in young adults with cerebral infarction due to moyamoya disease. I would like to add to their discussion by interjecting a note of caution about the nonspecificity of MRI in this condition. We reported the first use of MRI in moyamoya disease 2 in a patient initially thought to have multiple sclerosis (MS). Our patient, like most of those in the article by Bruno et al, was a young woman with fluctuating neurologic findings in whom the MRI showed multifocal bilateral areas of increased signal intensity ranging in size from 2 mm to 3 cm, with an appearance identical to that of MS plaques. Unlike their patients, her lesions were not concentrated in watershed areas, nor was the middle cerebral artery signal-void flow sign absent. Our patient also had abnormal brain-stem