Moyamoya disease (MMD) is an infrequent progressive cerebral pathology that primarily affects the branches of the internal carotid artery, resulting in stenosis of the internal carotid artery and subsequent development of multiple collateral vessels. As the disease advances, it manifests through various clinical presentations, including stroke and seizures. Prevalence rates indicate a higher incidence among individuals of Eastern Asian descent, while it is notably less common among African Americans. This case report describes the clinical presentation of a 32-year-old African-American female with a past medical history of sickle cell disease and stroke, who sought medical attention at our institution due to a deterioration in left-sided weakness and left wrist drop. Although the patient had been diagnosed with MMD at an early age, no previous medical records were available. Diagnostic evaluation utilizing brain imaging techniques confirmed the presence of MMD, exhibiting minute collaterals that had replaced the middle cerebral artery.