201 - Opening New Roads to Recovery in Moyamoya

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

JW

Justin Wang, MD

PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Co-Author(s)

BF

Brent Fogel, DO

PM&R Resident
Nassau University Medical Center
Melville, New York, United States
FB

Forrest Butensky, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
CK

Chi Lam Kwok, DO

PM&R Resident
Nassau University Medical Center
Rego Park, New York, United States
WG

Walter Gaudino, MD

Attending physician
Nassau University Medical Center
East Meadow, New York, United States

Submitter(s)

JW

Justin Wang, MD

PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Case Diagnosis: Moyamoya disease

Case Description: A 36-year-old woman with type 2 diabetes mellitus, hypertension, and hyperlipidemia presented with 12 hours of right-sided paresthesias of the neck which progressed to the right upper and lower extremities, along with transient dysarthria. Examination revealed right-sided sensory loss. Initial CT head was negative; CTA demonstrated symmetric narrowing of the bilateral M1 segments of the middle cerebral artery (MCA). MRI revealed an acute infarct in the left corona radiata, and MRA confirmed the CTA findings. Diagnostic cerebral angiography showed occlusion of the proximal right M1 with reconstitution distally. She underwent right-sided encephaloduroarteriosynangiosis (EDAS) for cerebral revascularization. Postoperatively the patient had mild residual sensory deficits and no motor weakness; she achieved independent ambulation. She was discharged home after evaluation by PM&R.

Discussions: Moyamoya disease is a vasculopathy of the intracranial vessels which causes progressive narrowing of large arteries with subsequent secondary development of small vessel collaterals. Adult-onset cases can present subtly and require a high index of suspicion. This patient’s presentation with isolated sensory deficits and transient dysarthria shows the importance of comprehensive neurologic and functional assessment, as deficits not obvious on strength testing may still impact safety and independence. For physiatrists, early involvement is critical for assessing mobility, sensation, and coordination, while also facilitating education on stroke symptom recognition and secondary prevention. Following EDAS, rehabilitation considerations include gradual activity progression and addressing subtle sensory-motor integration deficits to optimize recovery and reduce reinjury risk.

Conclusions: This case demonstrates the need for prompt recognition of atypical stroke etiologies and early interdisciplinary collaboration. In moyamoya disease, coordinated management between neurology, neurosurgery, and PM&R can promote safe discharge, restore function, and minimize long-term disability. Even when motor deficits are minimal, targeted rehabilitation and patient education are essential for sustained independence and quality of life.