Moyamoya Disease- A Clinical Mimic for Psychiatric Disorders in the Emergency Setting: A Case Report

Patient presentations to the emergency department for mental health evaluations are common, with an estimated 1 in 4 adult visits made for this reason. These presentations are often accompanied by vague symptomatology, which may make it difficult to determine if they are because of another medical condition. Previous evaluations may bias future presentations, leading to premature closure before correctly identifying a causative underlying medical condition. Accurate, timely diagnosis improves health care costs by decreasing inappropriate treatments and unnecessary admissions and lowering the risk of recidivism. A 32-year-old woman presented with a complaint of recurrent neuropsychological symptoms attributed incorrectly to a primary mental disorder. On representation, she was found on computed tomography angiogram imaging to have pathognomonic findings for moyamoya disease. A short review of neuropsychological presentations previously attributed to moyamoya disease is reviewed. Because of the frequency with which we encounter patients for a mental health evaluation and the multifaceted harms of misdiagnosis, emergency providers should be familiar with moyamoya disease as a cause of mental disorders due to another medical condition.