Stroke Mimics in Children With Moyamoya Arteriopathy

Background: Comorbid conditions may result in symptoms that mimic stroke in children with moyamoya arteriopathy. Health care usage for stroke mimics is not well characterized. Methods: Consecutive children (aged <18 years) with moyamoya syndrome or disease treated at a single center (2007-2021) were identified from a registry. Data including documentation of headache, anxiety, and functional neurologic disorders were retrospectively abstracted using standardized forms. Encounters were attributed to the comorbid condition when (1) related symptoms led to the visit; (2) the condition was documented as the visit diagnosis; and (3) in the absence of stroke, transient ischemic attack, or seizure. Results: We identified 32 children (63% female) with symptomatic moyamoya arteriopathy diagnosed via imaging at a median age of 7.5 years (range, 0.7-17) years, all treated with revascularization surgery. During follow-up (median, 6.7 years after diagnosis [interquartile range, 4.0-8.3]), 81% of patients reported headache, 53% reported anxiety, 19% reported panic attacks, and 6% developed a functional neurologic disorder. Both patients with functional neurologic disorder also had migraines and anxiety. In 10 patients (31% of the cohort), a stroke mimic led to 33 emergency department encounters and 9 hospital admissions; 9 received head imaging (magnetic resonance imaging, computed tomography, or computed tomographic angiography) as part of the workup. Conclusion: Headaches, anxiety, and functional neurologic disorders may mimic stroke symptoms in children with moyamoya arteriopathy, leading to significant health care usage. While providers should remain vigilant for stroke, early recognition of stroke mimics should promote interventions to address comorbid conditions.