These findings suggested a causal link might exist between leptospiral exposure and MMD.Īfter entering the 21st century, leptospirosis has been controlled at a pretty low prevalence in China (Zhang et al., 2012). Recently, epidemiologic studies from China uncovered the onset of MMD shows a clustered regional pattern, and leptospirosis may explain a cluster observed in Hubei province (Ma et al., 2021 Zhang et al., 2022). During this period, a unique neurologic disorder named leptospiral cerebral arteritis was broadly reported over China, which interestingly presented typical angiographic and pathological features of MMD (Liu et al., 1980 Liu et al., 1978). In the second half of the 20th century, leptospirosis severely threatened public health in China. Genetic studies have identified RNF213, as a susceptibility gene for MMD, but the low penetrance in genetically susceptible individuals suggests that a second hit is necessary to trigger disease onset (Asselman et al., 2022). MMD is a leading cause of stroke for both children and young adult, while the etiology remains largely unclear. Moyamoya disease (MMD), a cerebrovascular disorder characterized by chronic progressive occlusion of the terminal internal carotid artery and dilated collateral microvessels near the base skull, developing collateral circulation like “puff of smoke” on angiography (Suzuki & Takaku, 1969).
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