BACKGROUND

Moyamoya angiopathy (MMA) is a rare cause of stroke, yet its incidence and outcomes are understudied in Southeast Asia, despite being the third most populous geographical region in the world. Our aim was to enhance understanding of MMA in this population and present a case from our experience

A systematic literature search on MMA in the Southeast Asian population was performed via PubMed, Scopus, and Wiley Online Library, including local journals and databases up until May 2024. Descriptive statistics were used to synthesize data. We also present a case of a 36 year-old Filipino female diagnosed with MMAfollowed by superficial temporal artery-middle cerebral artery (STA-MCA) bypass and resolution of symptoms.

Out of the 275 articles retrieved, 23 articles detailing 37 patients of Southeast Asian nationality were included in this review. Stroke predominated (76.3%, n=29) as initial presentation, followed by seizures (36.8%, n=14), movement disorders (n=4, 10.5%) and headaches (n=4, 10.5%). Treatment included antiplatelet therapy for 57.9% (n=22), and anti seizure medications for 26.3% (n=10) of cases. Only 21% (n=8) underwent surgical intervention, primarily via direct bypass. Outcomes based on the Modified Rankin Scale (MRS) showed 94.7% (n=36) had retained a functional score of MRS ≤2.

Our review underscores the scarcity of data on MMAin Southeast Asians, and highlights the varied clinical presentation. Effective management requires a tailored approach, with surgical management showing favorable outcomes. Future research should focus on longitudinal studies to assess long-term outcomes, explore the genetic and environmental factors, and develop standardized treatment protocols to improve patient care in this ethnically diverse population.

Conducting and writing quality improvement studies is a skill that every family and community physician should learn and apply in their practice. As family and community physicians it is one of our responsibilities to provide quality health care to our patients.1 Simply put, “quality” is doing the right thing right the first time and doing it better the next. Similar to the doctor-patient interaction in a typical consult, where the physician’s objective is to learn as much as possible about the patient’s signs and symptoms and medical history in order to make the right diagnosis and thus render the right treatment. The physician strives to do all this on the first visit and hopes to keep up-to-date on the condition so that when another patient presents with the same condition, he or she will receive better and more current care.