The patient was discharged without neurological deficits 20 days after the hemorrhagic stroke.<h4>Conclusion</h4>Presence of an <i>RNF213</i> variant and choroidal anastomosis may represent risk factors for cerebral hemorrhage in patients with Down syndrome and moyamoya syndrome, as well as in patients with moyamoya disease. The gene discussed is RNF213; the disease is Moyamoya disease.