Combined spinal epidural anaesthesia for caesarean section for a parturient with moyamoya disease and sickle cell disease 

• Introduction

• Moyamoya disease is an occlusive internal carotid arteriopathy. Small ‘moyamoya’ vessels (Japanese for puff of smoke) develop within the brain¹

• Moyamoya disease is often associated with sickle cell disease (SCD)

• Case Background

  • 36 year old primiparous woman 

   

  • Elective caesarean section at 37/40

   

  • SCD and moyamoya diagnosed following ischaemic stroke, treated with pial synangiosis

   

  • MRI: severe bilateral ICA narrowing