Moyamoya syndrome: Post cranial irradiation of pineal gland tumor

A right-handed eight-year-old boy, with headache, vomiting and positive parinaud 's sign was diagnosed as having a pineal gland tumor which histopathological section from surgical biopsy revealed to be a germinoma. The patient underwent ventriculoperitoneal shunt for obstructive hydrocephalus. Thereafter, he received cranial irradiation as definitive treatment. He was well and went back to school until five years later he developed a transient ischemic attack. Cranial magnetic resonance imaging showed a complete cure of the pineal tumor without any other specific abnormality. Eight months later he had an episode of stroke which was demonstrated by cranial computed tomography as acute left cerebral infarction in the middle cerebral artery territory. Cerebral angiography showed Moyamoya syndrome.