Comprehensive Physiotherapy Management in a Patient with Acute Stroke Secondary to Moya Moya Disease: A Case Report

Abstract Moya Moya Disease (MMD) is a rare, chronic, and progressive cerebrovascular disorder characterized by the bilateral, stenotic occlusion of the terminal portions of the internal carotid arteries and the proximal parts of the anterior and middle cerebral arteries [1]. This progressive narrowing leads to the formation of a fine, collateral vascular network at the base of the brain, visualized on angiography as a "puff of smoke"—the Japanese term from which the disease derives its name [2]. The resultant chronic cerebral hypoperfusion can precipitate both ischemic events (transient ischemic attacks or strokes) and haemorrhagic strokes due to the fragility of the compensatory collateral vessels [3]. The clinical presentation of MMD varies widely based on the dominant pathology. Ischemic presentations typically manifest as recurrent transient ischemic attacks (TIAs) exacerbated by hyperventilation, headache, or progressive neurological deficits, including hemiparesis, cognitive decline, or seizures [4]. Definitive treatment often involves medical management primarily focuses on symptom control and surgical revascularization aimed at improving cerebral blood flow and reducing the risk of future events [5]. Despite optimal medical and surgical intervention, patients often present with significant residual neurological impairments following a stroke, which necessitates intensive neurorehabilitation. Physiotherapy plays a critical role in addressing the sequelae of an Upper Motor Neuron (UMN) lesion, including spasticity, paresis, and functional mobility deficits. While MMD is a specific and distinct vasculopathy, the resulting motor impairment patterns often resemble those of conventional stroke, demanding evidence-based, goal-oriented rehabilitation [6]. However, the literature is sparse regarding detailed, measurable physiotherapy protocols and their efficacy specifically in patients recovering from MMD-related stroke, especially those presenting with complex bilateral motor and cranial nerve involvement. This case report aims to detail the comprehensive physiotherapy management of a patient diagnosed with MMD, demonstrating significant functional and neurological recovery over a short, intensive period.