A Rare Case of Moyamoya Disease in a Hispanic Woman: Unveiling Non-Asian Ethnicity and Atypical Risk Factors.

BACKGROUND Moyamoya disease is a rare and progressive cerebrovascular disorder caused by narrowed or blocked arteries supplying the brain. First described in Japan, the disease's incidence is higher in Asian countries and primarily affects children, although adults can also be afflicted. Following a literature review, very little was found regarding non-Asian ethnicities and the lack of typically associated risk factors that are known correlates of Moyamoya disease. CASE REPORT We present the case of a 41-year-old Hispanic woman with a history of type 1 diabetes mellitus and asthma who presented to the Emergency Department with concerns of recurrent transient episodes of left upper extremity weakness and paresthesia followed by confusion. The patient's blood pressure on arrival was 215/134 mmHg, and heart rate was 124 beats per min. Computed tomography of the head was unremarkable, but a computed tomography angiogram of the head demonstrated several areas of severe and bilateral stenosis with radiographic appearances, suggestive of Moyamoya disease. Magnetic resonance imaging of the brain would later illustrate two 6×2-mm ischemic infarcts in the right posterior centrum semiovale. CONCLUSIONS Moyamoya disease in the non-Asian population is rarely reported. We present a case of this condition in a patient of Hispanic ethnicity. Although it is generally considered a non-atherosclerotic disease, some literature suggests that atherosclerotic disease may also contribute to the development and possible acceleration of clinical features of Moyamoya disease. Given our patient's risk factors, we postulated that our patient's presentation was likely multifactorial, with both non-sclerotic and atherosclerotic disease.

Acquired Long QT Syndrome: Ventricular Fibrillation in an Otherwise Healthy Young Female.

Long QT syndrome (LQTS) occurs when there is an abnormality of myocardial repolarization characterized specifically by a prolonged QT interval on an electrocardiogram (ECG). This can be particularly dangerous as it is associated with an increased risk of polymorphic ventricular tachycardia and a life-threatening arrhythmia otherwise known as torsades de pointes (TdP). We present a case of a 40-year-old Indian female whose medical history was significant only for anemia and depression/anxiety that presented in a ventricular fibrillation cardiac arrest after becoming dyspneic and light-headed while dancing. Of relevance, she was taking sertraline 50mg once daily, a class of medications known to prolong the QT interval as well as having low serum calcium on presentation. Both her initial and subsequent electrocardiograms illuminated significantly prolonged QTc intervals. She subsequently sustained a ventricular tachycardia cardiac arrest, which degenerated into ventricular fibrillation in the cardiac intensive care unit two days later. Ultimately, the patient was pronounced brain-dead by the end of the week. We concluded this to be a case of LQTS predisposing to TdP, which then would degenerate into ventricular fibrillation. This case highlights multiple risk factors that are known to predispose to the aforementioned etiology. Further research is needed not only on common medications and their dose-dependent relationship on the QT interval across different ethnic groups but also on educating providers regarding multiple risk factors they may or may not have the power to control.