Neurology-Psychiatry Interface: Uncommon Presentation of Moyamoya Disease

Moyamoya disease (MMD) is a rare arteriopathy associated with cerebral ischemia, due to stenosis or occlusion of the internal carotid artery and its branches and primarily presenting with stroke. However, neuropsychiatric symptoms such as acute psychosis, manic symptoms, attention deficits, and behavioral problems are reported in relation to MMD. We describe here a case of an adult female, who presented with headache, easy irritability, and suspiciousness against family members, inability to identify familiar objects and faces, and inability to perform activities easily done earlier. This case appears informative as the presence and excessive importance given to behavioral symptoms lead to substantial delay in her diagnosis.