Abstract
Introduction: Moyamoya disease (MMD) is an uncommon cerebrovascular occlusive condition characterized by progressive narrowing and obstruction of the circle of Willis. Sporadic cases have been documented in the literature from North Africa.
This study presents the most comprehensive reported series of MMD cases in North Africa, emphasizing their characteristics compared with those of the largest series.
Method: We reported the clinical symptoms, imaging findings, and surgical outcomes of nine patients with Moyamoya disease using data collected from 2019 to 2022.
Results: In comparison with the Southern European population, females and pediatric patients were more frequently affected. The severity of symptom onset, neurological impairment, and vessel involvement diminished with increasing age. A review of the literature identified seven cases of Moyamoya disease (MMD) within the North African region, where authors often misdiagnosed Twig-like middle cerebral artery or Moyamoya syndrome as MMD.
Statistical analysis indicates the progression of the stenosis-occlusive phenomenon within the vessel. Anterior vessels, specifically the internal carotid arteries (ICAs), are involved significantly more frequently than posterior vessels, namely the posterior cerebral arteries (PCAs; p = 0.0009), thereby supporting the hypothesis of anteroposterior progression. This observation is further corroborated by a highly significant Chi-square test result (p = 0.0009). Right-to-left laterality is suggested, with a sequential progression in the following order: right ICA, left ICA, right PCA, and left PCA; however, this trend does not reach statistical significance (p = 0.0748).
Conclusion: Moyamoya disease is infrequent in North Africa and primarily impacts pediatric patients. Our series illustrates a distinctive anteroposterior pattern of vascular involvement and highlights the common diagnostic confusion with similar entities documented in the regional literature. These findings highlight the need for improved recognition and precise classification of MMD in this population.
