Why would neurosurgeon performing angiogram state "It's a mystery why the left middle cerebral artery is completely occluded."   No stroke, just TIA.  (and not aware of having one, showed up on scan after car accident) Working diagnosis is Moyamoya but he is not yet 100% certain about that either.  CT Perfusion soon, then he said he would know something.  Anyone have the same issue?

I think physicians with little experience with moyamoya might say things like this.  And most don't have it.  The neurologist at Sloan-Kettering told us that for most neuros, moyamoya is a question on a test in medical school and they never see it again. 

My husband's moyamoya was discovered when he had a head CT and MRI after passing out in the bathroom.  He was undergoing chemotherapy for cancer at the time.  Three Sloan-Kettering neurologists identified moyamoya, and still -- the stroke neurologist they sent him too at NYP-Weill Cornell refused to believe that what he was seeing was moyamoya.  He saw a middle-aged guy with collaterals and narrowed arteries and automatically assumed he had atherosclerosis.  He prescribed a carotid angiogram and they were so certain that he needed an endarterectomy to clear out plaque that they scheduled it even before the antiogram!  Well, lo and behold, the neck was clear and the endarterectomy became EDAS.  And still they told him to stay on Lipitor.  And this was a top hospital.

If I had it to do over again, I would have insisted that we go to Stanford to see Gary Steinberg, who is the lead guy in the country for moyamoya.  But my husband wanted to stay with his existing team. 

Ask your neurosurgeon to send the angiogram results to Dr. Steinberg for a second opinion.