We present the case of a 23-year-old Vietnamese male with a
2-year history of a psychotic illness marked by prominent negative
symptoms, fatuousness and disturbed behavior. Neuroimaging revealed
a prominent vascular flow void affecting the middle and anterior
cerebral arteries, with associated increased collateral supply
to the frontal cortex, consistent with Moyamoya disease.
Neurological examination was unremarkable; however,
neuropsychological assessment revealed significant executive
dysfunction, including stimulus-driven behavior. Whilst the
diagnosis of schizophrenia and Moyamoya disease may be
coincidental, an interaction between the 2 diseases may have
led to some of the atypical features of this case, including
prominent executive dysfunction and marked sensitivity to
psychotropic medication. We discuss the nature of possible
interactions between the 2 conditions. This case also highlights
the importance of re-evaluating patients with atypical or
treatment-resistant psychoses for cerebral pathology.
(JINS, 2003, 9, 806–810.)