Role and Safety of Plasmapheresis in the Treatment of Moyamoya Syndrome

We are presenting a case of Graves’ disease with acute deterioration in mental status secondary to moyamoya syndrome that developed because of untreated severe thyrotoxicosis. The patient did not respond well to medications used to treat thyrotoxicosis and underwent plasmapheresis aiming to improve symptoms and neurologic outcome. After one session of plasmapheresis, she developed cerebral herniation. This article will focus in brief on the role of plasmapheresis in the treatment of complicated cases and the safety of this procedure, especially in critically ill patients.