Recognizing The ‘Ivy Sign’: A Radiologic Hallmark in Pediatric Moya Moya Disease

Moya Moya disease is a rare, progressive cerebrovascular disorder characterized by stenosis or occlusion of the terminal portion of the internal carotid arteries and the development of abnormal vascular networks. The “Ivy sign” is a characteristic Magnetic resonance imaging (MRI) finding frequently encountered in patients with Moya Moya. It is due to the formation of leptomeningeal collateral development and increased numbers of pial vascular webs. We report a case of a 4-year-old female who presented with experienced generalized tonic-clonic seizures and had a history of ischemic stroke in 2024 and was diagnosed to have Moya Moya disease, including the presence of the “Ivy sign”.