Psychotic disorder with predominating visual hallucinations in moyamoya disease: a case report

Moyamoya disease (MMD) is a rare, chronic occlusive cerebrovascular disorder. A small number of patients may present with psychiatric symptoms, such as depression, anxiety, and cognitive impairment. However, psychotic disorders predominantly characterised by visual hallucinations are exceedingly rare, with only three cases reported in the literature to date. We describe a case of MMD presenting with a psychotic disorder in which visual hallucinations were the prominent feature, and review the relevant literature. An 11-year-old girl was admitted to our hospital presenting with limb shaking. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) revealed occlusions at the terminal portions of both internal carotid arteries, significant stenosis of the right posterior cerebral artery, and the development of a collateral vascular network at the base of the brain. Following a diagnosis of MMD, she underwent revascularisation surgery for the right hemisphere, which was performed successfully. However, two years after operation, the patient developed psychiatric symptoms, including visual hallucinations and fear. These symptoms resolved completely after treatment with quetiapine and sertraline with no recurrence observed over a 5-years follow-up period. This case report aims to enhance clinical recognition of psychiatric symptoms in patients with Moyamoya disease, and to emphasise that a multidisciplinary approach involving neurology and psychiatry services for early diagnosis and appropriate management is crucial for significantly improving patient prognosis.