Moyamoya is characterized by stenosis of intracranial arteries, usually involving the ICA, ACA, and MCA (Gross et al., Hemorrhagic and Ischemic Stroke). The disease typically plesents with prominent lenticulostriate and thalamic perforating arteries, which contribute to the "puff of smoke" appearance (Gross et al.). The incidence of moyamoya is higher in Asian-American populations (Gross et al.), and the patient presented in this case was a female of Korean descent. 

Procedure performed and dictated by Rakesh Shah, M.D. Case courtesy of Rakesh Shah, M.D.