Adult-onset moyamoya disease with repetitive ischemic attacks successfully treated by superficial temporal-middle cerebral artery bypass--case report.

A 78-year-old Japanese woman presented with adult-onset moyamoya disease manifesting as repetitive ischemic attacks over a period of 26 years. Initial ischemic attack occurred at age 52 years. Neurological status deteriorated, associated with worsening in angiographical and single photon emission computed tomography findings over the last 10 years. She suffered frequent transient attacks of aphasia and right hemiparesis. Superficial temporal-middle cerebral artery anastomosis was performed. Postoperative angiography and single photon emission computed tomography revealed a marked increase in cerebral blood flow and symptoms showed considerable improvement. Direct revascularization may be the treatment of choice even for aged patients with moyamoya disease.