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Neuropediatrics 2022; 53(03): 204-207
DOI: 10.1055/s-0041-1739131
Short Communication

Moyamoya Syndrome in an Infant with Aicardi–Goutières and Williams Syndromes: A Case Report

Jagraj S. Brar
1   Department of Pediatrics, Division of Pediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
2   Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
3   Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
,
Rahul Verma 
2   Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
3   Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
,
Mohammed Al-Omari
2   Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
3   Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
4   Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
,
Victoria M. Siu
2   Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
3   Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
5   Division of Medical Genetics, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
,
Andrea V. Andrade
2   Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
3   Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
4   Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
,
Michael T. Jurkiewicz
3   Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
6   Department of Medical Imaging, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
,
Saptharishi Lalgudi Ganesan 
1   Department of Pediatrics, Division of Pediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
2   Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
3   Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
› Author Affiliations Funding The authors have no financial relationships relevant to this article to disclose.
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Abstract

Stroke in infancy is a rare phenomenon but can lead to significant long-term disability. We present the story of a 6-month-old Old Order Amish infant with underlying Williams syndrome, a rare neurodevelopmental disorder caused by a microdeletion, encompassing the elastin gene that produces abnormalities in elastic fibers of the lungs and vessels. This infant presented with lethargy, irritability, and a new-onset generalized tonic-clonic seizure. Brain magnetic resonance imaging (MRI) was consistent with ischemic stroke in the supratentorial regions. MR angiogram demonstrated bilateral narrowing of the internal carotid arteries with “ivy sign,” suggestive of Moyamoya. Moyamoya disease/syndrome is a cerebrovascular condition that is associated with progressive stenosis of the intracranial vessels and can cause ischemic stroke in young children. Targeted mutation analysis revealed a homozygous c.1411–2A > G splice site variant in the SAMHD1 gene, consistent with a diagnosis of Aicardi–Goutières syndrome type 5 (AGS5), an autosomal recessive condition with multisystem involvement. In our unique case of infantile stroke with Moyamoya syndrome and dual diagnosis of Williams syndrome and AGS5, both diagnoses likely contributed to the cerebrovascular pathology. This case report highlights the importance of suspecting and testing for multiple genetic abnormalities in children presenting with Moyamoya-related stroke.

Keywords

williams syndrome - moyamoya syndrome - stroke - SAM domain and HD domain-containing protein-1 - aicardi–goutières syndrome

Author Contributions

All authors participated in creating content for the manuscript, editing, and provided final approval for submission. No undisclosed authors contributed to the manuscript.


Supplementary Material



Publication History

Received: 11 April 2021

Accepted: 04 September 2021

Article published online:
01 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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