Wasp Sting-Associated Occlusion of the Supraclinoid Internal Carotid Artery: Implications Regarding the Pathogenesis of Moyamoya Syndrome

To the Editor. —The earliest pathologic changes in moyamoya syndrome are stenotic and/or occlusive changes in the terminal portion of the internal carotid artery. 1 The cause of moyamoya syndrome, particularly the influence of congenital and/or acquired factors, remains undefined. Suzuki 2 has been the chief proponent of a pathogenetic mechanism that involves the interaction of the autonomic nervous system (local factor) and the immune system (systemic factor). We report wasp sting-associated occlusion of the terminal internal carotid artery, and suggest that this may have similar implications regarding the pathogenesis of moyamoya syndrome. Report of a Case. —A previously healthy, developmentally normal 34-month-old white boy was stung repeatedly on the inner upper lip near the midline. The father removed a live yellow jacket from the child's mouth. There were no stings in the posterior aspect of