At the age of 18, this boy experienced transient right upper extremity weakness associated with dysarthria and right facial weakness.

Our patient had specific facial features, brachiocephaly, up-slanted and narrow palpebral fissures, shortened digits, hypotonia, and joint hyperextensibility, characteristic of trisomy 21 or Down syndrome. He also had hypothyroidism and sleep apnea but no underlying congenital heart disease. His stroke was due to moyamoya syndrome.