Abstract

Moyamoya vasculopathy is a progressive vasculopathy leading to stenosis of main intracranial arteries with the formation of collaterals, which gives a puff of smoke appearance. If it is due to associated condition, it is termed as moyamoya syndrome .one of such association is hyperhomocysteinemia, which is a rare association. Very few cases have been reported in India. Here we report a case of 32-year-old female non-hypertensive, non-diabetic, presented with history of recurrent left side hemiplegia with left UMN Facial nerve palsy. Her routine blood investigations were normal except for macrocytic hyperchromicanemia. On MR Angiography, she was diagnosed to have moyamoyavasculopathy. Thrombophilia profile revealed hyperhomocysteinemia, Which usually present as ischemic stroke, but in our scenario patient presented with moyamoya syndrome, along with intracranial hemorrhage due to fragility of collaterals .In this case, her hyperhomocysteinemia is attributed to low vitamin b 12 and folic acid levels. So simple vitamin b12 and folic acid deficiency can cause hyperhomocysteinemia , which in turn leads to stroke in young .Thus nutritional anemia should be corrected as early as possible so that its deleterious effects are prevented.