Jessica didn't know what to think when her doctor told her she had moyamoya disease. "It sounded like some exotic illness from another country," she recalls.

Moyamoya is in fact a very rare brain disorder. Its name originated across the ocean – in Japan -- and the doctors capable of treating it are few and far between.

But Jessica, a 24-year-old phlebotomist at Cincinnati's University Hospital, was fortunate. The microsurgical procedure she needed was available right where she worked.

Under the leadership of Mario Zuccarello, MD, a neurosurgeon with the Mayfield Clinic and Director of Cerebrovascular Surgery at the University of Cincinnati Neuroscience Institute(UCNI) at University Hospital, UCNI is emerging as an important treatment center for patients suffering from moyamoya disease.

Moyamoya is characterized by a chronic and progressive narrowing of the carotid arteries where they enter the brain, causing debilitating strokes and seizures in children and adults.

The presence of moyamoya is confirmed by a series of imaging studies that can reveal the characteristic arterial narrowing. To compensate for the narrowing arteries, the brain creates collateral blood vessels in an attempt to facilitate the flow of oxygen-rich blood. These tiny collateral vessels, when seen on a brain scan, have a hazy, filmy appearance—the "puff of smoke" that gives the disorder its Japanese name.

Jessica's troubles began in August 2007. A nursing student, she was typing on a computer when she suddenly was unable to lift one of her hands. "I knew something was wrong," she recalls, "but I didn't know that I was having a stroke."

The incident passed, but Jessica had a similar experience later that week and was admitted to the hospital. In December, following yet another episode, during which she could not lift one of her arms, she came under the care of Matthew Flaherty, MD, Assistant Professor of Neurology at UC and a member of The Neuroscience Institute. After ordering several tests, including conventional cerebral angiography, Dr. Flaherty made the diagnosis of moyamoya disease. He then referred Jessica to Dr. Zuccarello for surgery.

Prior to surgery, Jessica's mother, Mary, knew that her daughter wasn't herself. She seemed listless and less responsive than usual. "She let the bath water run without turning it off," Mary recalls. "It happened twice. I said, ‘Do you see what's happening?' "

The treatment for moyamoya, which is not widely offered, involves surgically bypassing the blocked arteries. In the most delicate and technically challenging bypass procedure, called an extracranial-intracranial bypass, Dr. Zuccarello connects the superficial temporal artery from the scalp outside the skull to the middle cerebral artery inside the skull.

For Mary, sitting anxiously in the waiting room, the procedure seemed endless. But for Jessica, it was remarkably routine. The six-hour operation took place on a Thursday, and Jessica went home the next day.

“Having surgery wasn't as scary as having a stroke,” she says.

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