A 47-year-old woman came to the UCSF emergency department with acute slurred speech along with left-sided facial droop and left-sided numbness, suggesting a stroke. Vessel imaging showed bilateral obstructive arteriopathy, an indication of moyamoya disease. On further review of her symptoms, she also reported subacute findings of ongoing difficulty with attention and memory. Her discharge plan included a prescription for a daily statin and daily aspirin and referrals to vascular neurologist Anirudh Sreekrishnan, MD, at the UCSF Stroke Clinic, and vascular and endovascular neurosurgeon Luis E. Savastano, MD, PhD, at the UCSF Cerebrovascular Neurosurgery Clinic.
Personalized multidisciplinary care
At the patient’s follow-up appointment, Savastano performed an angiogram, which showed bilateral M1 obliterative arteriopathy (occlusive on the right and near occlusive on the left) with enlarged medial lenticulostriate collaterals supplying the basal ganglia and robust posterior and anterior cerebral artery collaterals reconstituting the middle cerebral artery. As these findings confirmed moyamoya disease, surgical intervention was planned.
Sreekrishnan and the team at the stroke clinic helped the patient focus on neurovascular optimization of her risk factors. She worked on losing weight and controlling her cholesterol and blood pressure. The management strategy combined medications with diet and lifestyle changes. She started to recover from her left-sided numbness and facial droop but continued to report ongoing difficulty with memory and thinking.
A few months after the patient’s initial emergency department visit, Savastano performed a successful right-sided superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Since the procedure, the patient has returned almost entirely to baseline, is able to perform activities of daily living, and reports that her thinking and concentration have improved. She continues having follow-up visits to the stroke clinic for help with managing her risk factors and is committed to maintaining a healthy lifestyle that includes exercise, weight control and optimal nutrition.
“Our expert surgical and medical teams worked in conjunction to provide comprehensive care to not only help the patient recover from her initial event but, importantly, to prevent an event in the future,” Sreekrishnan said.
Nationally recognized specialty center
Both clinics are part of the UCSF Comprehensive Stroke Center, certified as a comprehensive stroke center – the highest credential – by the Joint Commission, American Heart Association and American Stroke Association.
The center provides the most advanced diagnostic methods and treatments for stroke patients and those at risk of stroke. Patients have access to a wide range of specialty care, including emergency medicine, vascular surgery, neurosurgery, neuroanesthesiology, diagnostic neuroradiology, neurocritical care, vascular neurology and neurointerventional radiology. Highly trained physical and occupational therapists, speech therapists, nurses, pharmacists, case managers, social workers and medical technologists are also members of the expert team.
Neurology and neurosurgery research and treatment take place within the UCSF Weill Institute for Neurosciences.
To learn more
UCSF Cerebrovascular Neurosurgery Clinic
Phone: (415) 353-7500 | Fax: (415) 353-2889
Refer a patient
UCSF Stroke Clinic
Phone: (415) 353-8897 | Fax: (415) 353-8705
Refer a patient
Clinical trials
