{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T07:54:44Z","timestamp":1774511684981,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"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":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Moyamoya syndrome (MMS) is a rare progressive cerebrovascular disorder causing stenosis of intracranial arteries and collateral vessel formation. Pediatric presentations often include ischemic strokes, and coexisting Thalassemia Major may worsen vascular outcomes. A 3\u2010year\u2010old male with Thalassemia Major presented with acute right\u2010sided weakness, altered consciousness, and a prior left\u2010sided stroke. Examination revealed facial asymmetry, aphasia, and right\u2010sided hemiparesis. Laboratory tests excluded metabolic, infectious, and cardio\u2010embolic causes. MRI Brain with contrast and TOF\u2010MRA demonstrated chronic right\u2010sided changes, acute left\u2010sided ischemia, and marked narrowing of the supraclinoid and cavernous segments of the left internal carotid artery, confirming Moyamoya disease, Suzuki stage 3. The patient received aspirin (3\u2009mg\/kg\/day) and supportive care. After 5\u2009days, neurological status improved (GCS 14, right limb power 3\/5). Surgical revascularization via EDAS was advised but deferred due to financial constraints. This case highlights alternating hemiparesis as a rare pediatric MMS presentation, the diagnostic utility of MRI\/MRA, and the impact of socio\u2010economic limitations on access to definitive surgical care.<\/jats:p>","DOI":"10.1002\/ccr3.72176","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:45:08Z","timestamp":1773006308000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How Far Can we Go? Managing Moyamoya Syndrome in a 3\u2010Year\u2010Old With Thalassemia Major: A Rare Pediatric Case From Nepal"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1524-4491","authenticated-orcid":false,"given":"Kshitiz","family":"Parajuli","sequence":"first","affiliation":[{"name":"Department of Pediatrics Birat Medical College and Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3855-450X","authenticated-orcid":false,"given":"Abhisek","family":"Jha","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Birat Medical College and Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9142-9661","authenticated-orcid":false,"given":"Aron","family":"Neupane","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Birat Medical College and Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9963-7481","authenticated-orcid":false,"given":"Shristi","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Birat Medical College and Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nischal","family":"Timsina","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Birat Medical College and Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5070-8503","authenticated-orcid":false,"given":"Sagar","family":"Bhagat","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Birat Medical College and Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2103-8735","authenticated-orcid":false,"given":"Raja Babu","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Birat Medical College and Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anand","family":"Sah","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Birat Medical College and Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anup","family":"Katwal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Birat Medical College and Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1969.00480090076012"},{"issue":"12","key":"e_1_2_13_3_1","first-page":"1227","article-title":"Moyamoya Disease and Moyamoya Syndrome","volume":"364","author":"Scott R. 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