Dr Shyamanta Das
Moyamoya is a chronic, progressive, occlusive disease of blood supply to the brain and is often an important cause of stroke at a young age. Congenital rubella syndrome consists of sensorineural hearing defects, eye abnormalities such as cataract, microphthalmia, and retinopathy, along with heart defects; in rare cases, it affects the brain.
In a case study published in the Open Journal of Psychiatry & Allied Sciences (OJPAS), authors Robin Victor, Vrinda Saxena, Shailendra Raghuvanshi, and Ravi Gupta report a 20-year-old female patient from North India, presenting with headache, irritability, low mood, loss of interest in daily activities, and progressive cognitive decline in the form of poor scholastic performance for the past four years. She had a history of hemiparesis four years ago and was operated for congenital cataract; her mother had rubella infection in the antenatal period.
The patient was investigated, and, diagnosed as persistent depressive, with left-sided hemiparesis in remission with moyamoya disease, based on history, examination, and relevant investigation (magnetic resonance imaging [MRI] brain/magnetic resonance [MR] angiogram). The cognitive decline can be due to congenital rubella, persistent depressive disorder, moyamoya disease, or a combination of any of these three diagnoses. It also signifies the presence of psychiatric comorbidities which are often not evaluated in chronic progressive diseases, and, therefore, the need for a consultation-liaison approach while dealing with such patients is recommended.