Hi, welcome to our family, sorry that you find us  but you come to right place.  I dianosiged MM on Jan and moyamoya is the first word I hear in my life, this site is very helpful and supportive ( hat of for DJ ).  There was people in this site who has MM and surgery done live in Hawaiee, you track back old topic you will find it, you can also contact w/ dr. in states to get there opinion.  42 is not to old for surgery, I'm 36 and just get my left side done on Apr 7.  Lots of peoples go to Dr. Steinberg in Standford, Califonia, my surgeon is Dr.Tamargo @ Johns Hopkins Hospital Baltimore, Maryland.  You can also search on surgeon w/ bypass experience, there is a list of wonderful Dr. from all over country who perform surgery as well.
I have 2 opinion from 2 surgeon and both told me surgery is the only treatment for MM, and it the only change for me to live longer, so take charge in your hand, you can also tell your brother Dr. to go to this web site to learn more about MM( that what I did with  my local ER doctor when they don't listen to me
Sorry for talking to much, you take care, your brother is in my though and prayer, update to let us know.

Kieu

Hi GP, sorry you had to find us, but glad we could be here for you!

As for your brother's age, 42 is definitely not too old to have surgery for MM.  There are several people on this site who have had surgery at older ages than that.

Most of what has been studied and written on MM shows medicinal treatments are not effective and will not prevent further "episodes" which makes interim treatment for your brother presenting with a hemorrhage kind of tricky.

Normally, once someone is diagnosed with MM, they are put on a regiment of aspirin or some stronger version of a blood thinner to try and prevent strokes and TIA's until surgical treatment can be performed.  As your brother has already had a hemorrhage, a blood-thinner probably won't be an option (obviously, just my  )

I would strongly suggest you contact a MM specialist on the main land as soon as possible to see if they can give you any suggestions or recommendations on treatment options.  Links to  Dr's Steinberg and Scott's email addresses are listed on the "Surgeons with Bypass Experience" board along with many other surgeons who have had at least some experience with MM.

Finally... Shan, from Hawaii, has put together a support group for people in Hawaii called "Hawaii Moyamoya Ohana".  I'm sure it would be very helpful for you to contact their group for some local support.  You can read about the group and find her email address by clicking on her profile name at the following address: http://www.moyamoya.com/cgi-bin/yabb/YaBB.cgi?board=localmeet;action=display;num=1129910766

Hope this information helps and please let us know if you have any more questions!

Welcome to the family!! 

DJ

Hi, GP.  Welcome to the group.   You've already gotten some great responses.   I just wanted to add that I, too, have seen others on the board who were around your brother's age or older when they had surgery.

I also thought I would share that when my daughter had two strokes, she was 15 months old, and her doctor thought she was too young and too involved to be a surgical candidate.  In fact, her doctors in Philadelphia thought she would die within a matter of weeks, and we took her home from the hospital on hospice.

We contacted Dr. Steinberg and got a very different opinion.   Daphne had surgery on both sides about 6 weeks after her strokes.  That was more than a year ago, and Daphne is still around, and is a very happy and healthy 2 year old (although not without her problems relating to damage that had already been caused by moyamoya prior to surgery)

I just thought I'd share this experience to reiterate how important it is to see a surgeon who has vast experience with Moyamoya disease. 

Jenny

Hi GP and welcome to the MM family,

My brother Kevin (Cubbie) had surgery at age 47 as a result of MM. He too had a significant stroke and was sent home to live out whatever life he had left. To make a long story short, I sent his films to Dr. Steinberg at Stanford and within a few days, I received a response. The rest is history. Today is Kevin's one year surgery anniversary. He has done very well and he is currently at Stanford for a one year follow up.  I can only ditto  Jenny's post and what DJ said (second opinion) and what Mar mentioned about seeking a second opinion from a MM Specialist like Dr. Steinberg at Stanford and seending your brother's films to him.  Dr. Steinberg will view your brother's films and render his opinion at no charge. It doesn't get any simpler or easier than that.

Please know we are all here to support you and to assist in any way we can. Please ask any questions and let us know how your brother is doing.

You and your brother will be in my thoughts and prayers.

Lore