Moyamoya disease with refractory hypertension associated with peripheral arterial stenosis in the renal parenchyma

Moyamoya Vasculopathy and Moyamoya-Related Systemic Vasculopathy: A Review With Histopathological and Genetic Viewpoints

Systemic vasculopathy has occasionally been reported in cases of moyamoya disease (MMD). Since the pathological relationship between moyamoya vasculopathy (MMV) and moyamoya-related systemic vasculopathy (MMRSV) remains unclear, it was examined herein by a review of histopathologic studies in consideration of clinicopathological and genetic viewpoints. Although luminal stenosis was a common finding in MMV and MMRSV, histopathologic findings of vascular remodeling markedly differed. MMV showed intimal hyperplasia, marked medial atrophy, and redundant tortuosity of the internal elastic lamina, with outer diameter narrowing called negative remodeling. MMRSV showed hyperplasia, mainly in the intima and sometimes in the media, with disrupted stratification of the internal elastic lamina. Systemic vasculopathy has also been observed in patients with non-MMD carrying the RNF213 (ring finger protein 213) mutation, leading to the concept of RNF213 vasculopathy. RNF213 vasculopathy in patients with non-MMD was histopathologically similar to MMRSV. Cases of MMRSV have sometimes been diagnosed with fibromuscular dysplasia. Fibromuscular dysplasia is similar to MMD not only in the histopathologic findings of MMRSV but also from clinicopathological and genetic viewpoints. The significant histopathologic difference between MMV and MMRSV may be attributed to a difference in the original vascular wall structure and its resistance to pathological stress between the intracranial and systemic arteries. To understand the pathogeneses of MMD and MMRSV, a broader perspective that includes RNF213 vasculopathy and fibromuscular dysplasia as well as an examination of the 2- or multiple-hit theory consisting of genetic factors, vascular structural conditions, and vascular environmental factors, such as blood immune cells and hemodynamics, are needed.

Moya Moya Disease: A rare disease with a common presenting symptom in a chronic kidney disease patient

Moya Moya Disease (MDD) is a rare cerebrovascular pathology. It is non atherosclerotic cerebrovascular disease characterized by bilateral internal carotid stenosis or occlusion, and abnormal vascular network at the base of the brain. Here we report a case of young female who presented in emergency with complaints of jerky movements of limbs for six months and history of recently developed unusual high blood pressure which was followed by uremic symptoms. Her workup revealed severe renal dysfunction required kidney replacement therapy (KRT) i.e., hemodialysis. During hospital stay her mental status deteriorated with a drop in GCS. Brain imaging performed and she found to have MMD. Her clinical course continued to deteriorate despite of extensive work up and aggressive management, she died eventually.

Multislice Computed Tomography Angiography Imaging Diagnosis of Lower Extremity Arteriosclerosis in Patients with Hypertension and Its Correlation with the Level of High-Sensitivity C-Reactive Protein

The aim of this study was to investigate the relationship between multislice computed tomography (CT) angiography (MSCTA) imaging and high-sensitivity C-reactive protein (hs-CRP) in patients with hypertension and lower extremity arteriosclerosis. 68 hypertensive patients with lower extremity arteriosclerosis were selected as the observation group, and 68 healthy volunteers were selected as the control group to compare the differences in hs-CRP. According to the degree of stenosis, the patients were further divided into five grades: no obvious stenosis, mild stenosis, moderate stenosis, severe stenosis, and occlusion. The correlation between the degree of stenosis and the content of hs-CRP was compared. The changes of hs-CRP content before and after treatment were compared, and the difference of images before and after surgical treatment and the difference of hs-CRP expression in patients with occlusion were compared. Compared with the control group, the content of hs-CRP in the observation group was significantly higher ( $P<0.05$ ), and the degree of stenosis was positively correlated with the content of hs-CRP. After two weeks of treatment, the hs-CRP levels of patients with severe stenosis and occlusion were significantly lower than those before treatment ( $P<0.01$ ). The level of hs-CRP in patients with occlusion after arterial stent intervention was significantly lower than before, and the images also showed that the blood vessels were significantly expanded. The degree of stenosis in patients with lower extremity arteriosclerosis diagnosed by MSCTA imaging was closely related to the expression of hs-CRP in the patient, and a sustained high concentration of hs-CRP corresponded to a more severe degree of vascular occlusion. In conclusion, the hs-CRP can be used as one of the factors to predict and evaluate the occurrence of cardiovascular and cerebrovascular diseases.

Research progress of moyamoya disease combined with renovascular hypertension

Moyamoya disease (MMD) is an idiopathic cerebrovascular disease which was first described by Suzuki and Takaku in 1969. Moyamoya disease is a non-atherosclerotic cerebrovascular structural disorder. MMD has been found all over the world, especially in Japan, Korea, and China. In recent years, many reports pointed out that the changes of vascular stenosis in patients with moyamoya disease occurred not only in intracranial vessels, but also in extracranial vessels, especially the changes of renal artery. Renovascular hypertension (RVH) is considered to be one of the important causes of hypertension in patients with moyamoya disease. The pathogenesis of moyamoya disease combined with renovascular hypertension is still unclear, and the selection of treatment has not yet reached a consensus. This article reviews the latest research progress in epidemiology, RNF213 gene, pathomorphology, clinical characteristics and treatment of moyamoya disease combined with renovascular hypertension, in order to provide reference for clinical workers.