{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:32:17Z","timestamp":1790260337053,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Moyamoya disease (MMD) is a rare progressive cerebrovascular disorder characterized by stenosis of the terminal internal carotid arteries with fragile collateral vessel formation. It is common in East Asia but underreported in Nepal. Pediatric cases typically present with ischemic symptoms such as transient ischemic attacks, stroke, or seizures. We report a 7\u2010year\u2010old Nepali boy with 11\u2009days of fever followed by recurrent tonic\u2013clonic seizures, progressive right\u2010sided weakness, and impaired fine motor function. Examination showed right hemiparesis with an upgoing plantar reflex. MRI and MR angiography revealed multiple acute infarcts with supraclinoid internal carotid artery stenosis and extensive collateral vessels, confirming MMD. Cerebrospinal fluid and autoimmune workup were unremarkable. The child was managed conservatively with aspirin and levetiracetam, leading to partial recovery. Surgery was deferred due to financial limitations and initial improvement. This case underscores the importance of considering MMD in pediatric strokes in non\u2010endemic regions. In resource\u2010limited settings like Nepal, conservative treatment offers symptomatic relief, but long\u2010term follow\u2010up is essential to monitor progression and surgical needs.<\/jats:p>","DOI":"10.1002\/ccr3.70947","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T04:11:16Z","timestamp":1759810276000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pediatric Moyamoya Disease in Nepal and Challenges in a Resource\u2010Limited Setting: A Case Report"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0183-261X","authenticated-orcid":false,"given":"Kapil","family":"Khanal","sequence":"first","affiliation":[{"name":"Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM) Tribhuvan University (TU)  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Dhungana","sequence":"additional","affiliation":[{"name":"Department of Pediatric Medicine Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM), Tribhuvan University (TU)  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bindu","family":"Gyawali","sequence":"additional","affiliation":[{"name":"Department of Pediatric Medicine Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM), Tribhuvan University (TU)  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishab","family":"Khanal","sequence":"additional","affiliation":[{"name":"Department of Pediatric Medicine Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM), Tribhuvan University (TU)  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binit","family":"Bajracharya","sequence":"additional","affiliation":[{"name":"Department of Pediatric Medicine Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM), Tribhuvan University (TU)  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6266-9745","authenticated-orcid":false,"given":"Nishant","family":"Neupane","sequence":"additional","affiliation":[{"name":"Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM) Tribhuvan University (TU)  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4611-3032","authenticated-orcid":false,"given":"Nijan","family":"Sharma","sequence":"additional","affiliation":[{"name":"Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM) Tribhuvan University (TU)  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4645-5321","authenticated-orcid":false,"given":"Kailash Mani","family":"Pokhrel","sequence":"additional","affiliation":[{"name":"Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM) Tribhuvan University (TU)  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0583-1448","authenticated-orcid":false,"given":"Manish","family":"Acharya","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM), Tribhuvan University (TU)  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreya","family":"Sinha","sequence":"additional","affiliation":[{"name":"Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM) Tribhuvan University (TU)  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"StatPearls","author":"Karsonovich T.","year":"2025"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.14.1.104"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2015.01627"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.490714"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.21981"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000114140.41509.14"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000448314"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10143\u2010018\u20100994\u20105"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.2176\/nmc.52.245"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1590\/0100\u20103984.2021.0010"},{"issue":"10","key":"e_1_2_13_12_1","article-title":"Moyamoya: An Update and Review","volume":"12","author":"Berry J. 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