Spicy food induced transient ischemic attack: A diagnostic conundrum in a child with moyamoya vasculopathy.

Moyamoya vasculopathy (MMV) is a rare progressive stenosis of the intracranial internal carotid arteries (ICA) and its branches with characteristic collateral formation.MMV frequently manifests in children as ischemic stroke or transient ischemic attack (TIA).The recognition of TIA in a child with MMV can be challenging due to the overlapping features seen with stroke-mimics, causing missed or delayed diagnosis.Ischemic symptoms seen in MMV are often triggered by hyperventilation, crying or exercise, but the association with spicy food is rare.We describe a boy with recurrent episodes of TIA associated with eating spicy food.After several misdiagnoses, a thorough re-evaluation and a magnetic resonance angiographic imaging confirmed the diagnosis of MMV.Neurosurgical revascularization surgery was performed with good postoperative outcome on follow-up.This case highlights the unusual association of spicy food and TIA in a child with MMV and illustrates the conundrum surrounding its diagnosis.