Moyamoya disease and arteriovenous fistula of the epiaortic vessels

The association of Moyamoya disease (MD) with other cerebrovascular disease has been reported in literature but not the occurrence of MD and arteriovenous fistula of the epiaortic vessels. A 61-year old Italian woman was admitted to our Department because of the sudden onset of Broca’s aphasia. At general examination she presented a murmur above the right clavicle. Brain magnetic resonance imaging (MRI) showed an ischemic lesion involving left frontal and temporal lobes. Cerebral digital subtraction angiography (DSA) showed moyamoya vessels and an arteriovenous fistula between vertebral artery and internal giugular vein in right laterocervical region. This is the first report of the association of MD with arteriovenous fistula of the epiaortic vessels.