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Kim JW, Hayashi T, Kim SK, Shirane R. Technical evolution of pediatric neurosurgery: moyamoya disease. Childs Nerv Syst 2023; 39:2819-2827. [PMID: 37395784 DOI: 10.1007/s00381-023-06017-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023]
Abstract
Moyamoya disease (MMD) is a rare steno-occlusive disease of the bilateral internal carotid arteries that predominantly occurs in East Asia. Since the first description of the MMD by Suzuki and Takaku in 1969, significant advances have been made in both basic and clinical understanding of the disease. The incidence and prevalence of pediatric MMD have increased, potentially due to improved detection rates. The advancement of neuroimaging techniques has enabled MRI-based diagnostics and detailed visualization of the vessel wall. Various methods of surgical treatments are successful in pediatric MMD patients, and recent studies emphasize the importance of reducing postoperative complications since the goal of MMD surgery is to prevent future cerebral infarction and hemorrhage. Long-term outcomes following appropriate surgical treatment in pediatric MMD patients have shown promising results, including favorable outcomes in very young patients. Further studies with a large patient cohort are needed to establish individualized risk group stratification for determining the optimal timing of surgical treatment and to conduct multidisciplinary outcome assessments.
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Affiliation(s)
- Joo Whan Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 03080, 101 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Toshiaki Hayashi
- Department of Pediatric Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurosurgery, Miyagi Children's Hospital, 4 Chome-3-17 Ochiai, Aoba Ward, Sendai, Miyagi, 989-3126, Japan
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 03080, 101 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea.
| | - Reizo Shirane
- Department of Neurosurgery, Miyagi Children's Hospital, 4 Chome-3-17 Ochiai, Aoba Ward, Sendai, Miyagi, 989-3126, Japan.
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Malone M, Ritchie D. The Mystery of a Unilateral Headache Ultimately Diagnosed as Moyamoya Disease. Cureus 2022; 14:e26816. [PMID: 35971361 PMCID: PMC9374177 DOI: 10.7759/cureus.26816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/05/2022] Open
Abstract
Moyamoya disease (MMD) is a rare chronic cerebrovascular occlusive disease characterized by progressive stenosis or occlusion of the intracranial internal carotid arteries and their proximal branches, with subsequent abnormally formed collateral vessels. Moyamoya disease is typically found in children of East Asian descent and is the most common pediatric cerebrovascular pathology in East Asian populations. However, moyamoya disease can be present without any predisposing factors, and this is what distinguishes the disease from the syndrome. Moyamoya syndrome is typically associated with other conditions such as sickle cell disease or neurofibromatosis. The syndrome can also be seen in patients who have had exposure to cervical or neck radiation. We present a rare case of an adult Peruvian woman who initially presented with a severe right hemispherical headache, which was ultimately diagnosed as MMD. This report and the discussion aim to provide more understanding of moyamoya disease and how it can be incidentally discovered in an unsuspected patient without any predisposing factors. The fact that the patient lacked any predisposing factors makes moyamoya disease, and not the syndrome, the diagnosis. Currently available treatments are limited. One specialized therapeutic approach is a procedure called encephaloduroarteriosynangiosis (EDAS), which aims to involve the transposition of a segment of a scalp artery onto the surface of the brain to permit the additional formation of collateral arteries. We aim to highlight the management and treatment of a case of moyamoya presenting as a severe right hemispherical headache in a patient without any predisposing factors.
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Sutton CXY, Carrazana E, Mitchell C, Viereck J, Liow KK, Ghaffari-Rafi A. Identification of associations and distinguishing moyamoya disease from ischemic strokes of other etiologies: A retrospective case-control study. Ann Med Surg (Lond) 2022; 78:103771. [PMID: 35734698 PMCID: PMC9206914 DOI: 10.1016/j.amsu.2022.103771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/07/2022] [Accepted: 05/08/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Better characterizing moyamoya disease (MMD) from ischemic strokes of other etiologies may facilitate earlier diagnosis by raising suspicion for a diagnostic work-up. Methods To identify associated variables, MMD cases (n = 12) were compared against three sets of controls: age-, sex-, and race-matched controls of patients with general neurological disorders (n = 48), unmatched general controls (n = 48), and unmatched non-MMD ischemic stroke controls (n = 48). Results MMD patients were 32 years (p < 0.0001) younger than ischemic stroke controls. Relative to non-MMD ischemic strokes, MMD patients had greater odds of presenting with visual field defects (OR: 9.13, p = 0.09) or dizziness (OR: 9.13, p = 0.09), as well as being female (OR: 8.04, p = 0.008), Asian (OR: 3.68, p = 0.087), employed (OR: 6.96, p = 0.02), having migraines (OR: 21.61, p = 0.005), epilepsy (OR: 6.69, p = 0.01), insomnia (OR: 8.90, p = 0.099), and a lower Charlson Comorbidity Index (CCI; p = 0.002). Patients with MMD, compared to non-MMD ischemic strokes, also had a 4.67 kg/ m2 greater body mass index (BMI) and larger odds (OR relative to normal BMI: 21.00, p = 0.03) of being from obesity class III (>40 kg/ m2), yet reduced odds of coronary artery disease (OR: 0.13, p = 0.02). Relative to general controls, MMD patients had greater odds of diabetes mellitus type 2 (OR: 10.07, p = 0.006) and hypertension (OR: 7.28, p = 0.004). Conclusion MMD not only has a unique clinical presentation from other ischemic strokes, but also unique comorbidities, which may facilitate earlier work-up and treatment. Moyamoya patients are 32 years younger than ischemic strokes of other etiologies. Moyamoya patients are 4.67 kg/ m2 heavier than those with ischemic strokes. Moyamoya patients are at greater odds of type 2 diabetes mellitus and hypertension. Moyamoya patients are at reduced odds of coronary artery disease. Moyamoya patients present more often with visual field deficits or dizziness.
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Begasse de Dhaem O, Robbins MS. Cognitive Impairment in Primary and Secondary Headache Disorders. Curr Pain Headache Rep 2022; 26:391-404. [PMID: 35239156 PMCID: PMC8891733 DOI: 10.1007/s11916-022-01039-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
Purpose of Review To critically evaluate the recent literature on cognitive impairment and headache. Recent Findings Neurocognitive symptoms are prevalent, debilitating, and occur often with both primary and secondary headache disorders. Summary This is a “narrative review of the current literature in PubMed on cognitive function and headache.” Migraine is associated with cognitive impairment years before a migraine diagnosis. In young and middle-aged adults, migraine is associated with deficits in attention, executive function, processing speed, and memory. It is unlikely that migraine is associated with dementia. Although methodologically difficult to assess, there does not seem to be an association between tension-type headache and cognitive dysfunction. In early to midlife, cluster headache seems to be associated with executive dysfunction. Several secondary headache syndromes relevant to clinicians managing headache disorders are associated with poorer cognitive performance or distinctive cognitive patterns, including those attributed to chronic cerebral or systemic vascular disorders, trauma, and derangements of intracranial pressure and volume, including frontotemporal brain sagging syndrome.
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Affiliation(s)
| | - Matthew S Robbins
- Department of Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
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Chiang CC, Shahid AH, Harriott AM, Tietjen GE, Savastano LE, Klaas JP, Lanzino G. Evaluation and treatment of headache associated with moyamoya disease - a narrative review. Cephalalgia 2021; 42:542-552. [PMID: 34786968 DOI: 10.1177/03331024211056250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Headache in patients with moyamoya disease is an under-addressed topic in the medical literature. Delay in the diagnosis of moyamoya disease or inappropriate treatment of headache could lead to devastating cerebrovascular outcome. With the evolving understanding of moyamoya disease, migraine pathophysiology, and various migraine-specific medications that have become available, it is crucial to provide an updated overview on this topic. METHODS We searched PubMed for keywords including moyamoya disease, moyamoya syndrome, headache in moyamoya, surgical revascularization, surgical bypass, migraine and moyamoya, and calcitonin gene-related peptide (CGRP). We summarized the literature and provide a comprehensive review of the headache presentation, possible mechanisms, the impact of various surgical revascularizations on headache in patients with moyamoya disease, and the medical management of headache incorporating novel migraine-specific treatments.Results and conclusion: The most common headache phenotype is migraine; tension-type headache, hemiplegic migraine, and cluster headache have also been reported. Most patients experience improvement of headache after surgical revascularization, though some patients report worsening, or new-onset headache after surgery. Given the complexity of moyamoya disease, careful consideration of different types of medical therapy for headache is necessary to improve the quality of life while not increasing the risk of adverse cerebrovascular events. More prospective studies are warranted to better understand and manage headache in patients with moyamoya disease.
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Affiliation(s)
- Chia-Chun Chiang
- Department of Neurology, 6915Mayo Clinic, Mayo Clinic, Rochester, MN
| | | | | | | | | | - James P Klaas
- Department of Neurology, 6915Mayo Clinic, Mayo Clinic, Rochester, MN
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Hackenberg A, Battilana B, Hebeisen M, Steinfeld R, Khan N. Preoperative clinical symptomatology and stroke burden in pediatric moyamoya angiopathy: Defining associated risk variables. Eur J Paediatr Neurol 2021; 35:130-136. [PMID: 34715507 DOI: 10.1016/j.ejpn.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the preoperative clinical and magnetic resonance imaging and angiography (MRI-MRA) characteristics in pediatric moyamoya patients. METHODS Analysis included 100 children with moyamoya angiopathy referred to our moyamoya center for preoperative evaluation. Clinical symptoms, neurological status using Pediatric Stroke Outcome Measurement (PSOM) and degree of disability on modified Rankin scale score (mRS) were evaluated. MRI-MRA evaluation included the assessment of ischemic lesions and involvement of posterior circulation. Data were analyzed for moyamoya disease (MMD), moyamoya syndrome (MMS) and age at disease onset. RESULTS Stroke was a common presentation in both MMD and MMS patients. TIAs and headaches/migraine were more frequent in MMD. There was no evidence of a difference in stroke burden on MRI as well as in PCA involvement between the two subgroups. Children <2 years had higher odds of having a stroke (OR 15.5, 95% CI 3.8-62.4, p < 0.001), recurrent stroke (OR 11.8, 95%CI 2.9-46.7, p < 0.001) and unfavorable mRS (≥2) (OR 4.2, 95% CI 1.3-13.7, p = 0.01) when compared to those >5 years of age. There was some evidence of association of PCA involvement with recurrent strokes (OR 3.1, CI 1.0-9.6, p = 0.05), a poor PSOM (OR 3.0, 95% CI 1.1-8.2, p = 0.04) and mRS (OR 3.1, 95% CI 1.2-8.3, p = 0.02). CONCLUSION Stroke seems to be a common presentation in both MMD and MMS patients. Early age at symptom onset and involvement of posterior circulation seem to be important risk factors for a high stroke burden and an unfavorable PSOM and mRS.
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Affiliation(s)
- Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital, University of Zurich, Switzerland; Moyamoya Center, University Children's Hospital, University of Zurich, Switzerland.
| | - Bianca Battilana
- Moyamoya Center, University Children's Hospital, University of Zurich, Switzerland
| | - Monika Hebeisen
- Moyamoya Center, University Children's Hospital, University of Zurich, Switzerland; Department of Biostatistics, Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Switzerland
| | - Robert Steinfeld
- Department of Pediatric Neurology, University Children's Hospital, University of Zurich, Switzerland
| | - Nadia Khan
- Moyamoya Center, University Children's Hospital, University of Zurich, Switzerland
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Clinical and Genetic Risk Factors of Long-Term Outcomes after Encephaloduroarteriosynangiosis in Moyamoya Disease in China. J Stroke Cerebrovasc Dis 2021; 30:105847. [PMID: 33992965 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This retrospective study was conducted to analyze the associations between ring finger protein 213 p.R4810K variant, clinical features and long-term outcomes in patients with moyamoya disease (MMD) after encephaloduroarteriosynangiosis treatment. MATERIALS AND METHODS A total of 2,545 patients with MMD in China were included in this study (median of follow-up duration: 32.00 months). Multiple Cox regression models were used to assess the associations between p.R4810K variant, clinical features and long-term outcomes. RESULTS For all patients, in multivariate Cox analysis, no association was observed between p.R4810K and long-term outcomes. Pediatric onset (HR, 0.38; 95%CI, 0.25-0.59) and headache (HR, 0.26; 95%CI, 0.08-0.83) were inversely and hypertension (HR, 1.43 95%CI, 1.06-1.94), diabetes (HR, 1.55; 95%CI, 1.00-2.40), bilateral lesions (HR, 2.73; 95%CI, 1.12-6.65) and posterior cerebral artery involvement (HR, 1.44; 95%CI, 1.08-1.90) were positively associated with follow-up stroke (all P < 0.05). Pediatric onset (HR, 0.46; 95%CI, 0.26-0.82) was inversely and hyperlipidemia (HR, 1.83; 95%CI, 1.23-2.73), smoking (HR, 1.86; 95%CI, 1.13-3.07), high Suzuki angiographic stage (HR, 1.71, 95%CI, 1.09-2.70), poor admission neurologic status (HR, 8.93; 95%CI, 6.49-12.29) and follow-up stroke (HR, 8.31; 95%CI, 6.01-11.49) were positively associated with poor neurologic outcome at the last follow-up visit (all P < 0.05). The factors were not consistent in the different groups of age at onset. CONCLUSIONS In our study, p.R4810K may play no role in long-term outcomes in Chinese MMD. Clinical features including age at onset, initial symptoms, risk factors of stroke, imaging, poor admission neurologic status were associated with poor outcomes in MMD after EDAS.
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Oh WO, Shim KW, Yeom I, Park IT, Heo Y. Features and diversity of symptoms of moyamoya disease in adolescents: A cluster analysis. J Adv Nurs 2021; 77:2319-2327. [PMID: 33426712 DOI: 10.1111/jan.14723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
AIMS The purpose of this study is to explore the symptoms experienced by adolescents with moyamoya disease and to identify the characteristics of each symptom cluster associated with moyamoya disease. DESIGN A retrospective and descriptive design, which is a secondary data analysis study based on electronic medical record data from hospitals. METHODS To assess the symptoms associated with moyamoya disease, a qualitative study was conducted on 12 adolescents, 12 caregivers and 12 experts on moyamoya disease. According to a qualitative study, 12 main symptoms (limb weakness, numbness, pins and needles, difficulty in speech, blurred vision, facial paralysis, hand tremors, involuntary movements, convulsions, dizziness, nausea/vomiting and headaches) were selected. Data were collected around these symptoms. The data collection was carried out through the Electronic Medical Record (EMR) data of 303 adolescents aged 13-19 who were diagnosed with moyamoya disease (ICD 10 Code: I67.5) between January 2010-December 2019 in a hospital in Seoul, South Korea. Cluster analysis was applied to identify symptom clusters with the hierarchical cluster agglomerative approach. We used the log-likelihood distance to measure the similarity of variables. Proximity between groups of variables was measured using the two-step method. RESULTS The physical symptoms experienced by adolescents with moyamoya disease were 'limb weakness' - the most common - followed by a 'headache,' 'difficulty in speech,' and 'nausea/vomiting.' A total of five symptom clusters were derived: cluster 1 was characterized by 'limb weakness'; cluster 2 participants were asymptomatic or experienced 'convulsions'; cluster 3 experienced 'difficulty in speech' and 'facial paralysis'; cluster 4 is prone to 'dizziness' and 'pins and needles'; and cluster 5 displays 'headaches' and 'nausea/vomiting'. CONCLUSION This study offers a multidimensional approach for identifying differences in clinical symptoms of moyamoya disease among adolescents. IMPACT These results will help provide interventions concerning the characteristics of the symptoms of moyamoya disease among adolescents.
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Affiliation(s)
- Won-Oak Oh
- College of Nursing, Korea University, Seoul, South Korea
| | - Kyu Won Shim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University Health System, Seoul, Korea
| | - Insun Yeom
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University Health System, Seoul, Korea
| | - Il Tae Park
- College of Nursing, Korea University, Seoul, South Korea
| | - YooJin Heo
- College of Nursing, Korea University, Seoul, South Korea
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Chatterjee S, Dubey S, Ray B, Ghosh R, Finsterer J, Lahiri D, Biswas R. Thunderclap headache and hemiparesis as presenting manifestation of adult moyamoya disease. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_320_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gao B, Kang K, Zhang J, Zhang D, Zhao X. Clinical Characteristics and Long-Term Outcome of Headaches Associated With Moyamoya Disease in the Chinese Population-A Cohort Study. Front Neurol 2020; 11:605636. [PMID: 33324340 PMCID: PMC7726238 DOI: 10.3389/fneur.2020.605636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/21/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Headache associated with Moyamoya disease (HAMD) in the Chinese population is not well-described. The long-term outcome of surgical revascularization and natural course of HAMD has not been disclosed either. Methods: A headache screening questionnaire in China based on the ICHD2 and a face-to-face interview performed by an experienced neurologist were used to investigate headache characteristics and frequency and pain intensity in the 3 months before admission, and a telephone interview was used for the follow-up of a large cohort of 119 Chinese patients with HAMD. Results: Headache intensity was rated as scores of 5.9 ± 2.0 on a visual analog scale (VAS), ranging from 0 to 10, in the 3 months before admission. Forty-six patients (38.6%) were categorized as having migraine-like headaches, 29 patients (24.3%) were categorized as having tension type-like headaches, and 44 patients (36.9%) had a combination of both. The majority of patients had migraine-like headaches (n = 34, 73.9%) with a migrainous aura. Both the frequency and intensity of the headache improved significantly in patients treated with surgical revascularization (n = 96, 80.7%) or the conservative treatment (n = 23, 19.3%) in a long-term follow-up. Conclusion: HAMD frequently presented with a migraine-like headache (75.5% in total). A tension type headache was present in 60.9% of patients. The symptom of dizziness is common in patients with HAMD (60.5%), and 19 of them (26.4%) met the diagnose of vestibular migraine. Both intensity and frequency of HAMD show a trend of spontaneous remission in a long-term follow-up, and there is no difference in long-term outcomes of HAMD between surgical revascularization and conservative treatment, which indicates that the effect of bypass intervention on HAMD may be a placebo effect.
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Affiliation(s)
- Bin Gao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Kaijiang Kang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jia Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Dong Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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D'Amico A, Ugga L, Cocozza S, Giorgio SMDA, Cicala D, Santoro C, Melis D, Cinalli G, Brunetti A, Pappatà S. Multimodal evaluation of the cerebrovascular reserve in Neurofibromatosis type 1 patients with Moyamoya syndrome. Neurol Sci 2020; 42:655-663. [PMID: 32651859 PMCID: PMC7843564 DOI: 10.1007/s10072-020-04574-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022]
Abstract
Purpose Moyamoya syndrome (MMS) is a rare intracranial arterial vasculopathy which can occur in neurofibromatosis type 1 (NF1) disease, representing a cause of cerebrovascular reserve (CVR) impairment, possibly leading to ischemic stroke. Here, we evaluated noninvasive imaging techniques used to assess CVR in MMS patients, describing clinical and imaging findings in patients affected by MMS-NF1. Methods Following strict inclusion and exclusion criteria, in this retrospective observational study, we evaluated imaging data of nine consecutive MMS-NF1 patients (M/F = 5/4, mean age: 12.6 ± 4.0). Subjects underwent a multimodal evaluation of cerebral vascular status, including intracranial arterial MR Angiography (MRA), MRI perfusion with dynamic susceptibility contrast (DSC) technique, and 99mTc-hexamethylpropyleneamine oxime (HMPAO) SPECT. Results In 8 out 9 patients (88.8%, 6/8 symptomatic), time-to-peak maps were correlated with the involved cerebral hemisphere, while in 6 out 9 patients (66.6%, 5/6 symptomatic), mean transit time (MTT) maps showed correspondence with the affected cerebrovascular territories. Cerebral blood flow (CBF) calculated using DSC perfusion failed to detect the hypoperfused regions instead identified by SPECT-CBF in all patients, while MTT maps overlapped with SPECT-CBF data in all cases and time-to-peak maps in 60.0%. Conclusions Although SPECT imaging still represents the gold standard for CBF assessment, our results suggest that data obtained using DSC perfusion technique, and in particular MTT maps, might be a very useful and noninvasive tool for evaluating hemodynamic status in MMS-NF1 patients. Electronic supplementary material The online version of this article (10.1007/s10072-020-04574-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessandra D'Amico
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
| | | | - Domenico Cicala
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Claudia Santoro
- Referral Centre of Neurofibromatosis, Department of Woman and Child, Specialistic and General Surgery, University "Luigi Vanvitelli", Naples, Italy
| | - Daniela Melis
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Sabina Pappatà
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
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Katano H, Nishikawa Y, Yamada H, Shibata T, Miyachi S, Mase M. Association of Superficial Temporal Artery Dilatation with Headache After Revascularization in Adult Moyamoya Disease. World Neurosurg 2019; 129:e594-e606. [PMID: 31158538 DOI: 10.1016/j.wneu.2019.05.228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The underlying mechanisms of headache in adult moyamoya disease (MMD) are not clear. The aim of this study is to clarify the factors that are associated with headache in adult patients with MMD after superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. METHODS We retrospectively analyzed the cases of 68 adult patients with MMD: 30 with surgery and 38 without surgery. Each STA-MCA anastomosis was performed by the standard technique. Magnetic resonance angiography (MRA) and single photon emission computed tomography were performed perioperatively. We stratified the intensity and frequency of the patients' headaches into 4 ranks. Pre- and postoperative STA diameters were retrospectively measured on digital subtraction angiography (DSA) and/or MRA. RESULTS In the surgery group, preoperative regional cerebral blood flow (rCBF) laterality and a postoperative rCBF increase >20% showed no significant difference between the patients with and without headache with a univariate analysis. The postoperative STA diameters of the distal branch (DSA) and main trunk (DSA/MRA) in the patients with headache were significantly larger than those of the patients without headache. The rate of postoperative increase of the STA diameters of the distal branch/main trunk was also significantly higher in the patients with headache than those without headache. A multivariate analysis showed that the standard regression coefficient β for sex, a >20% increase of postoperative rCBF, and the increase rate of the STA diameter of the distal branch shown by DSA was 0.37, 0.54, and 0.56, respectively. CONCLUSIONS The results of our analyses revealed that aside from ischemia, the postoperative increase rate of the STA may be a candidate reason for headache, especially in adult patients with MMD.
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Affiliation(s)
- Hiroyuki Katano
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Medical informatics & Integrative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Yusuke Nishikawa
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Yamada
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Teishiki Shibata
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shigenori Miyachi
- Department of Central Radiology, Nagoya City University Hospital, Nagoya, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Omer S, Zbyszynska R, Kirthivasan R. Peek through the smoke: a report of moyamoya disease in a 32-year-old female patient presenting with ischaemic stroke. BMJ Case Rep 2018; 2018:bcr-2017-221685. [PMID: 30093460 DOI: 10.1136/bcr-2017-221685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Moyamoya disease is a vasculopathy causing chronic progressive stenosis and occlusion of the large arteries of the circle of Willis that could lead to brain ischaemia. The condition may also present with haemorrhagic strokes. This is a case report of moyamoya disease in a 32-year-old woman presenting with ischaemic stroke. The report describes her inpatient stay and investigations and findings.The report reviews the main aspects of moyamoya disease definition, epidemiology, clinical features, diagnosis, classification and treatment. This case is interesting because her first presentation occurred after 3 months of her second delivery. Whether the different physiological stresses of pregnancy, child birth and puerperium have had some effect in accelerating the pathogenesis of her moyamoya disease remains unknown. 1.
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Affiliation(s)
- Siddiq Omer
- Care of the Elderly Medicine, Mid Essex Hospital Services NHS Trust, Chelmsford, UK
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14
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Nyholt DR, Borsook D, Griffiths LR. Migrainomics — identifying brain and genetic markers of migraine. Nat Rev Neurol 2017; 13:725-741. [DOI: 10.1038/nrneurol.2017.151] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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15
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Viana M, Afridi S. Migraine with prolonged aura: phenotype and treatment. Naunyn Schmiedebergs Arch Pharmacol 2017; 391:1-7. [PMID: 29143861 DOI: 10.1007/s00210-017-1438-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/03/2017] [Indexed: 01/03/2023]
Abstract
We review the published literature on migraine with prolonged aura (PA), specifically with regards to the phenotype and treatment options. PA is not uncommon. A recent study found that about 17% of migraine auras are prolonged and that 26% of patients with migraine with aura have experienced at least one PA. The characteristics of PA are similar to most typical auras with the exception of a higher number of aura symptoms (in particular sensory and/or dysphasic). There are no well-established treatments at present which target the aura component of migraine. Other than case reports, there have been open-label studies of lamotrigine and greater occipital nerve blocks. The only randomised, blinded, controlled trial to date has been of nasal ketamine showing some reduction in aura severity but not duration. A small open-labelled pilot study of amiloride was also promising. Larger randomised, controlled trials are needed to establish whether any of the existing or novel compounds mentioned are significantly effective and safe.
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Affiliation(s)
- Michele Viana
- Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy.
| | - Shazia Afridi
- Department of Neurology, Guy's and St Thomas' NHS Trust, London, UK
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Tozzi E, Antenucci A, Di Loreto S, Maresca M, Farello G, Massimi L. O063. Moyamoya disease and headache: case report. J Headache Pain 2017; 16:A73. [PMID: 28132315 PMCID: PMC4759143 DOI: 10.1186/1129-2377-16-s1-a73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Elisabetta Tozzi
- Departments of Life, Health and Environmental Sciences, Neuropsychiatric, University Hospital of L'Aquila, L'Aquila, Italy.
| | - Annarita Antenucci
- Departments of Life, Health and Environmental Sciences, Pediatric, University Hospital of L'Aquila, L'Aquila, Italy
| | - Simona Di Loreto
- Departments of Life, Health and Environmental Sciences, Pediatric, University Hospital of L'Aquila, L'Aquila, Italy
| | - Maria Maresca
- Departments of Life, Health and Environmental Sciences, Pediatric, University Hospital of L'Aquila, L'Aquila, Italy
| | - Giovanni Farello
- Departments of Life, Health and Environmental Sciences, Pediatric, University Hospital of L'Aquila, L'Aquila, Italy
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Lee MJ, Lee C, Chung CS. The Migraine-Stroke Connection. J Stroke 2016; 18:146-56. [PMID: 27283278 PMCID: PMC4901947 DOI: 10.5853/jos.2015.01683] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/12/2016] [Accepted: 02/11/2016] [Indexed: 01/03/2023] Open
Abstract
Migraine and stroke are common neurovascular disorders which share underlying physiological processes. Increased risks of ischemic stroke, hemorrhagic stroke, and subclinical ischemic lesions have been consistently found in migraineurs. Three possible associations are suggested. One is that underlying pathophysiology of migraine can lead to ischemic stroke. Second, common comorbidities between migraine and stroke can be present. Lastly, some syndromes can manifest with both migraine-like headache and cerebrovascular disease. Future studies should be targeted on bidirectional influence of migraine on different stroke mechanisms and optimal prevention of stroke in migraine patients.
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Affiliation(s)
- Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - Chungbin Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
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Kraemer M, Lee SI, Ayzenberg I, Schwitalla JC, Diehl RR, Berlit P, Bosche B, Katsarava Z, Obermann M. Headache in Caucasian patients with Moyamoya angiopathy - a systematic cohort study. Cephalalgia 2016; 37:496-500. [PMID: 27112705 DOI: 10.1177/0333102416643516] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Headache is common in patients with Moyanoya angiopathy (MMA), but usually underestimated in its management and not well characterized. Methods A validated self-administered headache screening questionnaire and a telephone interview were used in order to investigate headache characteristics, frequency and pain intensity in a large cohort of 55 German patients with MMA. Results Thirty-seven patients (67.3%) had suffered from headache in the past year. Headache intensity was rated 3.2 ± 1.3 on a verbal rating scale from 0 to 10. Seventeen patients (47.9%) reported migraine-like headache, 10 patients (27.0%) reported tension type-like headache and 10 patients (27.0%) had a combination of both. The majority of patients with migraine-like headache ( n = 10, 58.8%) described migrainous aura. Headache frequency and intensity improved significantly after revascularization surgery; however, nine patients developed new-onset headache postoperatively. Conclusion Headache is very common in MMA, often with a migraine-like phenotype. Tension type-like headache was also found in 27% of patients, which is a new finding that has not been reported before.
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Affiliation(s)
- Markus Kraemer
- 1 Department of Neurology, Alfried-Krupp-Hospital Essen, Germany
| | - Sie-In Lee
- 1 Department of Neurology, Alfried-Krupp-Hospital Essen, Germany
| | - Ilya Ayzenberg
- 2 Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Bochum, Germany
| | | | - Rolf R Diehl
- 1 Department of Neurology, Alfried-Krupp-Hospital Essen, Germany
| | - Peter Berlit
- 1 Department of Neurology, Alfried-Krupp-Hospital Essen, Germany
| | - Bert Bosche
- 3 Department of Neurology and Headache Center, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Zaza Katsarava
- 4 Department of Neurology, Evangelic Hospital Unna, Germany
| | - Mark Obermann
- 3 Department of Neurology and Headache Center, University Hospital Essen, University of Duisburg-Essen, Germany.,5 Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
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Lvova OA, Jevneronok IV, Shalkevich LV, Prusakova TS. [Clinical manifestations of the onset and diagnostic problems in children with moyamoya disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:10-17. [PMID: 26977619 DOI: 10.17116/jnevro20161161110-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Moyamoya disease in children is a rarely diagnosed entity. Frequent headache is the first symptom of the disease. Headache associated with moya-moya disease (HAMD) is a separated entity reported in the literature. Variants of onset, a spectrum of primary diagnoses and diagnosis verification rate of moyamoya disease in 7 children are presented. A clinical case of moya-moya disease in a 9-year boy, who was primarily diagnosed with migraine with aura, is reported. The results presented by the authors as well as literature data indicate the necessity of using magnetic-resonance angiography in children with headache attacks and focal neurologic symptoms to identify this progressive vascular pathology and timely recommend a surgical treatment.
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Affiliation(s)
- O A Lvova
- Ural Federal University named after the first President of Russia Yeltsin, Yekaterinburg
| | - I V Jevneronok
- Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
| | - L V Shalkevich
- Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
| | - T S Prusakova
- Mogilev Regional Children Hospital, Mogilev, Belarus
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20
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Siddiqui BA, Jairam V, Johnson MH, Greer DM. Headache and focal neurologic signs following exposure to spicy aroma as an initial presentation of moyamoya disease. INTERDISCIPLINARY NEUROSURGERY 2014. [DOI: 10.1016/j.inat.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
BACKGROUND Migraine, particularly with aura, increases the risk for ischemic stroke, at least in a subset of patients. The underlying mechanisms are poorly understood and probably multifactorial. METHODS We carried out an extended literature review of experimental and clinical evidence supporting the association between migraine and ischemic stroke to identify potential mechanisms that can explain the association. RESULTS Observational, imaging and genetic evidence support a link between migraine and ischemic stroke. Based on clinical and experimental data, we propose mechanistic hypotheses to explain the link, such as microembolic triggers of migraine and enhanced sensitivity to ischemic injury in migraineurs. DISCUSSION We discuss the possible practical implications of clinical and experimental data, such as aggressive risk factor screening and management, stroke prophylaxis and specific acute stroke management in migraineurs. However, evidence from prospective clinical trials is required before modifying the practice in this patient population.
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Affiliation(s)
- Jerome Mawet
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA Emergency Headache Center, Lariboisiere Hospital, Assistance Publique-Hopitaux de Paris, France DHU NeuroVasc, France
| | - Tobias Kurth
- Inserm Research Center for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, France University of Bordeaux, College of Health Sciences, France Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA
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22
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Delayed posterior circulation insufficiency in pediatric moyamoya disease. J Neurol 2014; 261:2305-13. [DOI: 10.1007/s00415-014-7484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/28/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
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Frechette ES, Bell-Stephens TE, Steinberg GK, Fisher RS. Electroencephalographic features of moyamoya in adults. Clin Neurophysiol 2014; 126:481-5. [PMID: 25065300 DOI: 10.1016/j.clinph.2014.06.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/18/2014] [Accepted: 06/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Electroencephalography is useful for evaluating transient neurological events in the setting of moyamoya disease. METHODS EEG findings of adults with moyamoya seen at a large moyamoya referral center are summarized. Patients were identified by retrospective chart review. RESULTS EEGs were ordered after cerebral revascularization for altered mental status, aphasia, limb shaking, or facial twitching. Among the study population of 103 patients having EEGs, 24% of adults with moyamoya had a history of clinical seizures. Ischemic or hemorrhagic strokes were associated with a twofold relative risk of seizures. Overall, 90% of EEGs were abnormal, most commonly focally (78%), or diffusely slow (68%). Epileptiform EEG discharges were seen in 24%. Whereas hemispheres with an ischemic stroke had a 19% risk of epileptiform discharges and an 8% risk of seizures on EEG, hemispheres with hemorrhagic stroke had a 35% risk of epileptiform discharges and 19% risk of seizures on EEG. Focal amplitude attenuation was seen in 19%, breach rhythm in 15%, rhythmic delta in 14%, and electrographic seizures in 12%. CONCLUSIONS Seizures and epileptiform EEG changes are common in patients with moyamoya disease. SIGNIFICANCE Transient events in patients with moyamoya can result from seizures as well as ischemia.
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Affiliation(s)
- E S Frechette
- Fortanasce-Frechette Neurology Center, Arcadia, CA, United States. http://www.HealthyBrainMD.com
| | - T E Bell-Stephens
- Department of Neurosurgery, Stanford University School of Medicine, United States
| | - G K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, United States
| | - R S Fisher
- Department of Neurosurgery, Stanford University School of Medicine, United States; Department of Neurology and Neurological Sciences and Neurosurgery by Courtesy, Stanford University School of Medicine, United States.
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Xiang J, deGrauw X, Korman AM, Allen JR, O'Brien HL, Kabbouche MA, Powers SW, Hershey AD. Neuromagnetic abnormality of motor cortical activation and phases of headache attacks in childhood migraine. PLoS One 2013; 8:e83669. [PMID: 24386250 PMCID: PMC3873943 DOI: 10.1371/journal.pone.0083669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 11/06/2013] [Indexed: 11/18/2022] Open
Abstract
The cerebral cortex serves a primary role in the pathogenesis of migraine. This aberrant brain activation in migraine can be noninvasively detected with magnetoencephalography (MEG). The objective of this study was to investigate the differences in motor cortical activation between attacks (ictal) and pain free intervals (interictal) in children and adolescents with migraine using both low- and high-frequency neuromagnetic signals. Thirty subjects with an acute migraine and 30 subjects with a history of migraine, while pain free, were compared to age- and gender-matched controls using MEG. Motor cortical activation was elicited by a standardized, validated finger-tapping task. Low-frequency brain activation (1∼50 Hz) was analyzed with waveform measurements and high-frequency oscillations (65–150 Hz) were analyzed with wavelet-based beamforming. MEG waveforms showed that the ictal latency of low-frequency brain activation was significantly delayed as compared with controls, while the interictal latency of brain activation was similar to that of controls. The ictal amplitude of low-frequency brain activation was significantly increased as compared with controls, while the interictal amplitude of brain activation was similar to that of controls. The ictal source power of high-frequency oscillations was significantly stronger than that of the controls, while the interictal source power of high-frequency oscillations was significantly weaker than that of controls. The results suggest that aberrant low-frequency brain activation in migraine during a headache attack returned to normal interictally. However, high-frequency oscillations changed from ictal hyper-activation to interictal hypo-activation. Noninvasive assessment of cortical abnormality in migraine with MEG opens a new window for developing novel therapeutic strategies for childhood migraine by maintaining a balanced cortical excitability.
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Affiliation(s)
- Jing Xiang
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Xinyao deGrauw
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Abraham M. Korman
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Janelle R. Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Hope L. O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
| | - Marielle A. Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
| | - Scott W. Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Andrew D. Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
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Kim YO, Joo SP, Seo BR, Rho YI, Yoon W, Woo YJ. Early clinical characteristics according to developmental stage in children with definite moyamoya disease. Brain Dev 2013; 35:569-74. [PMID: 22951249 DOI: 10.1016/j.braindev.2012.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/31/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
Abstract
The objective is to clarify the early clinical characteristics in childhood moyamoya disease (MD). Epidemiologic characteristics, symptoms and diagnostic rates were assessed in 64 children (0-18 years) with definite MD according to developmental stage: infancy (5; 0-1 years); toddlerhood/preschool age (22; 2-5 years); school age (29; 6-10 years); and adolescence (8; 11-18 years). The median ages at onset was 6.25 years and the female to male ratio was 1.9 (~2.5 in toddlerhood/preschool age and in adolescence, P=0.71). Previous headache was observed in 23% (14/64): frequently in school age (38%, P=0.02) and within 6 months before main symptoms (6/11). As an initial symptom, weakness was observed in 78% (50/64) mainly as transient ischemic attack (TIA, 61%) in limbs (90%) and unilaterally (82%). TIA was less frequent in infancy (40%, P=0.04). Seizure was observed in 27% (17/64): frequently in infancy (100%, P<0.01), as the focal type (71%), and in the right extremity (3:1). Isolated seizures without other symptoms was frequent in children ~5 years (P<0.01). Severe headache associated with MD was observed in 14% (9/64). Provoking events were positive in 42% (27/64): in school age, frequently during eating (28%); and in toddlerhood/preschool age, during crying (27%). The diagnostic rates at 3 and 12 months from symptom-onset were 39% (80% during infancy vs. 28% in school age, P=0.14) and 67%, respectively. Symptomatic progression at diagnosis was observed in 38% (24/64). Initial clinical characteristics in childhood definite MD differed according to developmental stage and from at diagnosis.
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Affiliation(s)
- Young Ok Kim
- Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Republic of Korea.
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Viana M, Sprenger T, Andelova M, Goadsby PJ. The typical duration of migraine aura: a systematic review. Cephalalgia 2013; 33:483-90. [PMID: 23475294 DOI: 10.1177/0333102413479834] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND According to ICHD-II, and as proposed for ICHD-III, non-hemiplegic migraine aura (NHMA) symptoms last between five and 60 minutes whereas hemiplegic migraine aura can be longer. In ICHD-III it is proposed to label aura longer than an hour and less than a week as probable migraine with aura. We tested whether this was appropriate based on the available literature. METHODS We performed a systematic literature search identifying articles pertaining to a typical or prolonged duration of NHMA. We also performed a comprehensive literature search in order to identify all population-based studies or case series in which clinical features of NHMA, including but not restricted to aura duration, were reported, in order to gain a complete coverage of the available scientific data on aura duration. RESULTS We did not find any article exclusively focusing on the prevalence of a prolonged aura or more generally on typical NHMA duration. We found 10 articles that investigated NHMA features, including the aura duration. Five articles recorded the proportion of patients in whom whole NHMA lasted for more than one hour, which was the case in 12%-37% of patients. Six articles reported some information on the duration of single NHMA symptoms: visual aura disturbances lasting for more than one hour occurred in 6%-10% of patients, sensory aura in 14%-27% of patients and aphasic aura in 17%-60% of patients. CONCLUSIONS The data indicate the duration of NHMA may be longer than one hour in a significant proportion of migraineurs. This seems to be especially true for non-visual aura symptoms. The term probable seems inappropriate in ICHD-III so we propose reinstating the category of prolonged aura for patients with symptoms longer than an hour and less than one week.
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Affiliation(s)
- Michele Viana
- Headache Science Centre, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy
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Abstract
When deciding to perform imaging for headache, it is important to consider many factors including the pretest probability, prevalence of diseases, sensitivity of imaging, and implications for treatment. For the first presentation of a headache or a change in headache pattern, if the characteristics do not perfectly fit a primary headache type, imaging may be indicated according to the ICHD-2 criteria to exclude a secondary cause before a primary headache is diagnosed. The value of negative imaging should not be underestimated in the cost-benefit analysis, which often only takes into account number needed to treat or likelihood of finding a significant treatable abnormality. One study has shown that some groups of patients are less likely to overuse other parts of the health care system after negative neuroimaging. Further studies with stronger methodologies, finer differentiation of acute and chronic headache presentations, more advanced imaging technology, among other factors, can improve decision making on when to use imaging and assess the impact of imaging on patient satisfaction and quality of life. In addition, functional MRI, MRS, and voxel-based morphometry MRI are only some of the neuroimaging techniques currently used in research to further understand the pathophysiology and mechanisms of headache. In conclusion, although most headaches are a primary headache disorder with a benign course, imaging is an important part of the diagnostic evaluation to exclude the presence of a secondary cause of headache that could cause fatal results or severe neurologic morbidity. In headache patients without focal neurologic examination abnormalities, the yield of neuroimaging for significant intracranial findings is generally low. However, specific subgroups of headache patients and headache presentations can have much higher rates of significant intracranial abnormalities.
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Affiliation(s)
- Malisa S Lester
- Section of Neuroradiology, Department of Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA
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Kawabori M, Kuroda S, Nakayama N, Hirata K, Shiga T, Houkin K, Tamaki N. Effective surgical revascularization improves cerebral hemodynamics and resolves headache in pediatric Moyamoya disease. World Neurosurg 2012; 80:612-9. [PMID: 23022638 DOI: 10.1016/j.wneu.2012.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 03/26/2012] [Accepted: 08/15/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Headache is one of the major clinical presentations in pediatric Moyamoya disease. However, the clinical features and underlying mechanisms are not fully understood. This study aimed to clarify the clinical feature of headache in pediatric Moyamoya disease and the effect of surgical revascularization. METHODS This study included 29 pediatric patients who underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect bypass for Moyamoya disease. Their medical records were precisely evaluated to identify the clinical features of their headache. The findings on magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography also were analyzed. RESULTS Preoperative headache was documented in 11 (38%) of 29 patients. The majority of them complained of severe headache in the frontal or temporal region in the morning. Headache was significantly related to more advanced disease stage and to the decreases in cerebral blood flow and its reactivity to acetazolamide. Surgical revascularization completely resolved headache in all 11 patients. CONCLUSIONS These findings strongly suggest that disturbed cerebral hemodynamics may play key roles in developing severe headache in pediatric Moyamoya disease. STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis may be effective procedures to rapidly resolve headache by widely supplying collateral blood flow to the operated hemispheres.
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Affiliation(s)
- Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Verdure P, Le Moigne O, Massardier EG, Vanhulle C, Tollard E, Maltête D. Migraine-like headache and ocular malformations may herald Moyamoya syndrome. Rev Neurol (Paris) 2012; 168:460-1. [PMID: 22425396 DOI: 10.1016/j.neurol.2011.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 09/21/2011] [Accepted: 09/26/2011] [Indexed: 11/19/2022]
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