We report on a 6-year-old boy with a 2.5-year history of recurrent cerebral ischemic strokes and moderate systemic hypertension. Brain angio-MR examination revealed stenosis of cerebral arteries with a network of collateral vessels that are characteristic features for moyamoya disease. However, further examination, including angio-CT of abdominal vessels, revealed a significant stenosis of the aorta, celiac trunk and bilateral renal arteries. As the literature shows worse prognosis for moyamoya hypertensive patients having their blood pressure reduced, our patient, though hypertensive, remains disqualified for blood pressure reduction.