Objective: We report the first case series of comorbid Moyamoya disease (MMD) and Parkinson’s disease (PD).

Background: MMD is characterized by angiographic findings of bilateral stenosis or occlusion at the terminal end of internal carotid arteries along with abnormal collateral vascular network around narrowing arteries. Vascular parkinsonism has been reported as atypical presentations of MMD, but idiopathic PD has never been discussed with comorbid presumably genetic form of MMD.

Method: Case series

Results: We present two patients with prolonged history of MMD who developed parkinsonian symptoms after several years and one patient who diagnosed both with PD and asymptomatic MMD at the same time. Two patients previously diagnosed with MMD by transient ischemia attack without neurological sequalae or incidentally found at the regular check-up. No clinically significant structural lesions were found on the brain MRI of all cases. Dopamine transporter (DAT) imaging with ¹⁸F-FP-CIT PET showed severely decreased DAT densities with asymmetry and anteroposterior gradient, suggesting of synaptic terminal loss of nigrostriatal dopaminergic neurons in PD. Clinical manifestations of laterality were consistent with severity of decreased DAT uptakes and levodopa was effective in all patients.

Conclusion: MMD and PD do coexist although it is rare and the first report to our knowledge. The relevant pathophysiology needs to be elucidated through future post-mortem neuropathological studies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comorbid-moyamoya-disease-and-parkinsons-disease-a-case-series/