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Gorla G, Potenza A, Carrozzini T, Pollaci G, Acerbi F, Vetrano IG, Ferroli P, Canavero I, Rifino N, Bersano A, Gatti L. Angiopoietin-2 associates with poor prognosis in Moyamoya angiopathy. Ann Clin Transl Neurol 2024; 11:1590-1603. [PMID: 38655722 PMCID: PMC11187837 DOI: 10.1002/acn3.52076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/04/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE Moyamoya angiopathy (MA) is a rare cerebrovascular disorder characterized by recurrent ischemic/hemorrhagic strokes due to progressive occlusion of the intracranial carotid arteries. The lack of reliable disease severity biomarkers led us to investigate molecular features of a Caucasian cohort of MA patients. METHODS The participants consisted of 30 MA patients and 40 controls. We measured cerebrospinal fluid (CSF) levels of angiogenic/inflammatory factors (ELISA). We then applied quantitative real-time PCR on cerebral artery specimens for expression analyses of angiogenic factors. By an immunoassay based on microfluidic technology, we examined the potential correlations between plasma protein expression and MA clinical progression. A RNA interference approach toward Ring Finger Protein 213 (RNF213) and a tube formation assay were applied in cellular model. RESULTS We detected a statistically significant (p < 0.000001) up-regulation of Angiopoietin-2 (Ang-2) in CSF and stenotic middle cerebral arteries (RQ >2) of MA patients compared to controls. A high Ang-2 plasma concentration (p = 0.018) was associated with unfavorable outcome in a subset of MA patients. ROC curve analyses indicated Ang-2 as diagnostic CSF biomarker (>3741 pg/mL) and prognostic plasma biomarker (>1162 pg/mL), to distinguish stable-from-progressive MA. Consistently, MA cellular model showed a significant up-regulation (RQ >2) of Ang-2 in RNF213 silenced condition. INTERPRETATION Our results pointed out Ang-2 as a reliable biomarker mirroring arterial steno-occlusion and vascular instability of MA in CSF and blood, providing a candidate factor for patient stratification. This pilot study may pave the way to the validation of a biomarker to identify progressive MA patients deserving a specific treatment path.
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Affiliation(s)
- Gemma Gorla
- Laboratory of Neurobiology and UCV, Neurology IX UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
| | - Antonella Potenza
- Laboratory of Neurobiology and UCV, Neurology IX UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
- Department of Pharmacological and Biomolecular SciencesUniversity of MilanMilan20122Italy
| | - Tatiana Carrozzini
- Laboratory of Neurobiology and UCV, Neurology IX UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
| | - Giuliana Pollaci
- Laboratory of Neurobiology and UCV, Neurology IX UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
- Department of Pharmacological and Biomolecular SciencesUniversity of MilanMilan20122Italy
| | - Francesco Acerbi
- Neurosurgical UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
| | - Ignazio G. Vetrano
- Neurosurgical UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
- Department of Biomedical Sciences for HealthUniversity of MilanMilan20122Italy
| | - Paolo Ferroli
- Neurosurgical UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
| | - Isabella Canavero
- Laboratory of Neurobiology and UCV, Neurology IX UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
| | - Nicola Rifino
- Laboratory of Neurobiology and UCV, Neurology IX UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
| | - Anna Bersano
- Laboratory of Neurobiology and UCV, Neurology IX UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
| | - Laura Gatti
- Laboratory of Neurobiology and UCV, Neurology IX UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilan20133Italy
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Bautista-Lacambra M, Tejada-Meza H, Tique-Rojas LF, Vázquez-Sufuentes S, Palacín-Larroy M, Tejero-Juste C, Casado-Pellejero J, Marta-Moreno J. [Moyamoya in Aragon: epidemiology and self-perception of quality of life]. Rev Neurol 2023; 77:241-248. [PMID: 37962535 PMCID: PMC10831765 DOI: 10.33588/rn.7710.2023170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Moyamoya angiopathy is a vasculopathy caused by stenosis/occlusion of one or both intracranial internal carotid arteries. Although more common in Eastern countries, its prevalence is increasing in the West. An angioresonance or angiography is essential for its diagnosis. There are two options for treatment: conservative (medical) treatment or surgical bypass techniques. PATIENTS AND METHODS Nineteen patients were selected using International Classification of Diseases codes, and their demographic characteristics and health outcomes were studied. They were administered a scale for the screening of anxious-depressive syndrome (the Hospital Anxiety and Depression Scale - HADS) and another scale for self-perceived quality of life (SF-36). After applying the inclusion/exclusion criteria, eight of these patients were studied. RESULTS Nineteen patients were studied (52.63% male, 57.89% European) and the Aragonese prevalence was estimated at 1.37/100,000 inhabitants. The most frequent clinical presentation was ischaemic stroke (73.68%). The HADS detected two positive cases of anxiety and one case of depression. According to the SF-36, the worst self-rated aspects were vitality (median: 35/100) and general health (median: 42.5/100), while the best rated was physical function (mean: 93.57/100). CONCLUSIONS This is the Spanish series with the highest prevalence and the only one that addresses self-perceived health and screening of the anxious-depressive syndrome. Further research is needed to address this entity and determine its true prevalence in the West.
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Affiliation(s)
| | - H Tejada-Meza
- Universidad de Zaragoza, 50013 Zaragoza, España
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, España
- Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - M Palacín-Larroy
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, España
- Hospital Universitario Miguel Servet, Zaragoza, España
| | - C Tejero-Juste
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España
| | | | - J Marta-Moreno
- Universidad de Zaragoza, 50013 Zaragoza, España
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, España
- Hospital Universitario Miguel Servet, Zaragoza, España
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Gonzalez NR, Amin-Hanjani S, Bang OY, Coffey C, Du R, Fierstra J, Fraser JF, Kuroda S, Tietjen GE, Yaghi S. Adult Moyamoya Disease and Syndrome: Current Perspectives and Future Directions: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2023; 54:e465-e479. [PMID: 37609846 DOI: 10.1161/str.0000000000000443] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Adult moyamoya disease and syndrome are rare disorders with significant morbidity and mortality. A writing group of experts was selected to conduct a literature search, summarize the current knowledge on the topic, and provide a road map for future investigation. The document presents an update in the definitions of moyamoya disease and syndrome, modern methods for diagnosis, and updated information on pathophysiology, epidemiology, and both medical and surgical treatment. Despite recent advancements, there are still many unresolved questions about moyamoya disease and syndrome, including lack of unified diagnostic criteria, reliable biomarkers, better understanding of the underlying pathophysiology, and stronger evidence for treatment guidelines. To advance progress in this area, it is crucial to acknowledge the limitations and weaknesses of current studies and explore new approaches, which are outlined in this scientific statement for future research strategies.
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Saceleanu VM, Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, Dumitrascu DI, Bordeianu A, Corlatescu AD, Ciurea AV. Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations. Biomedicines 2023; 11:2617. [PMID: 37892991 PMCID: PMC10604797 DOI: 10.3390/biomedicines11102617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Among the high prevalence of cerebrovascular diseases nowadays, acute ischemic stroke stands out, representing a significant worldwide health issue with important socio-economic implications. Prompt diagnosis and intervention are important milestones for the management of this multifaceted pathology, making understanding the various stroke-onset symptoms crucial. A key role in acute ischemic stroke management is emphasizing the essential role of a multi-disciplinary team, therefore, increasing the efficiency of recognition and treatment. Neuroimaging and neuroradiology have evolved dramatically over the years, with multiple approaches that provide a higher understanding of the morphological aspects as well as timely recognition of cerebral artery occlusions for effective therapy planning. Regarding the treatment matter, the pharmacological approach, particularly fibrinolytic therapy, has its merits and challenges. Endovascular thrombectomy, a game-changer in stroke management, has witnessed significant advances, with technologies like stent retrievers and aspiration catheters playing pivotal roles. For select patients, combining pharmacological and endovascular strategies offers evidence-backed benefits. The aim of our comprehensive study on acute ischemic stroke is to efficiently compare the current therapies, recognize novel possibilities from the literature, and describe the state of the art in the interdisciplinary approach to acute ischemic stroke. As we aspire for holistic patient management, the emphasis is not just on medical intervention but also on physical therapy, mental health, and community engagement. The future holds promising innovations, with artificial intelligence poised to reshape stroke diagnostics and treatments. Bridging the gap between groundbreaking research and clinical practice remains a challenge, urging continuous collaboration and research.
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Affiliation(s)
- Vicentiu Mircea Saceleanu
- Neurosurgery Department, Sibiu County Emergency Hospital, 550245 Sibiu, Romania;
- Neurosurgery Department, “Lucian Blaga” University of Medicine, 550024 Sibiu, Romania
| | - Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 020022 Bucharest, Romania
| | - Horia Ples
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), “Victor Babes” University of Medicine and Pharmacy, 300736 Timisoara, Romania
- Department of Neurosurgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Andrei Bordeianu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Antonio Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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Zou X, Liao Y, Jiang C, Yuan Y, Zhao F, Ding D, Chen L, Xu B, Mao Y. Brain perfusion, cognition, and plasma Alzheimer's biomarkers in moyamoya disease. Alzheimers Dement 2023; 19:3316-3326. [PMID: 36762755 DOI: 10.1002/alz.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/06/2022] [Accepted: 12/22/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Because growing interest has been focusing on cerebral blood flow (CBF) to predict, prevent, and treat Alzheimer's disease (AD), it is important to clarify the role of CBF in AD pathology and cognitive decline. METHODS In a moyamoya disease (MMD) cohort, we examined CBF, specific cognitive domains, and plasma AD biomarkers, as well as correlations among these variables. RESULTS CBF was significantly reduced in newly diagnosed MMD patients, while plasma phosphorylated tau181 was elevated and positively correlated with hypoperfusion accumulation. MMD patients scored significantly lower than controls in multiple cognitive tests. Revascularization increased CBF to the recipient brain territories as well as cognitive performance but produced no significant change in AD biomarker levels. DISCUSSION These data suggest a link between accumulated reductions in CBF and cognitive decline, as well as a possible role of AD-like pathological burden. Further studies in MMD will provide opportunities to explore new treatment strategies.
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Affiliation(s)
- Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Yujun Liao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Conglin Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Yifan Yuan
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Fan Zhao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Ding Ding
- National Center for Neurological Disorders, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Tianqiao and Chrissy Chen International Institute for Brain Diseases, Shanghai, China
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, China
- Tianqiao and Chrissy Chen International Institute for Brain Diseases, Shanghai, China
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Carrozzini T, Pollaci G, Gorla G, Potenza A, Rifino N, Acerbi F, Vetrano IG, Ferroli P, Bersano A, Gianazza E, Banfi C, Gatti L. Proteome Profiling of the Dura Mater in Patients with Moyamoya Angiopathy. Int J Mol Sci 2023; 24:11194. [PMID: 37446373 DOI: 10.3390/ijms241311194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Moyamoya angiopathy (MMA) is an uncommon cerebrovascular disease characterized by a progressive steno-occlusive lesion of the internal carotid artery and the compensatory development of an unstable network of collateral vessels. These vascular hallmarks are responsible for recurrent ischemic/hemorrhagic strokes. Surgical treatment represents the preferred procedure for MMA patients, and indirect revascularization may induce a spontaneous angiogenesis between the brain surface and dura mater (DM), whose function remains rather unknown. A better understanding of MMA pathogenesis is expected from the molecular characterization of DM. We performed a comprehensive, label-free, quantitative mass spectrometry-based proteomic characterization of DM. The 30 most abundant identified proteins were located in the extracellular region or exosomes and were involved in extracellular matrix organization. Gene ontology analysis revealed that most proteins were involved in binding functions and hydrolase activity. Among the 30 most abundant proteins, Filamin A is particularly relevant because considering its well-known biochemical functions and molecular features, it could be a possible second hit gene with a potential role in MMA pathogenesis. The current explorative study could pave the way for further analyses aimed at better understanding such uncommon and disabling intracranial vasculopathy.
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Affiliation(s)
- Tatiana Carrozzini
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giuliana Pollaci
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, Università di Milano, 20133 Milan, Italy
| | - Gemma Gorla
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Antonella Potenza
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Nicola Rifino
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Experimental Microsurgical Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Biomedical Sciences for Health, Università di Milano, 20133 Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Anna Bersano
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Erica Gianazza
- Unit of Functional Proteomics, Metabolomics, and Network Analysis, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Cristina Banfi
- Unit of Functional Proteomics, Metabolomics, and Network Analysis, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Laura Gatti
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Filimonova E, Ovsiannikov K, Zaitsev B, Rzaev J. T1w/T2w ratio is associated with the brush sign and perfusion delay in watershed regions in patients with moyamoya angiopathy. Clin Neurol Neurosurg 2023; 231:107821. [PMID: 37302378 DOI: 10.1016/j.clineuro.2023.107821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/24/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND It has been shown recently using the T1w/T2w mapping technique that white matter microstructural integrity impairments exist in watershed regions patients with moyamoya angiopathy (MMA). We hypothesized that these changes could be associated with the prominence of other neuroimaging markers of chronic brain ischemia, such as perfusion delay and the brush sign. METHODS Thirteen adult patients with MMA (24 affected hemispheres) were evaluated using brain MRI and CT perfusion. The T1w/T2w signal intensity ratio, which reflects white matter integrity, was calculated in watershed regions (centrum semiovale and middle frontal gyrus). Brush sign prominence was evaluated with susceptibility-weighted MRI. Additionally, brain perfusion parameters such as cerebral blood flow (CBF), cerebral blood volume (CBF), and mean transit time (MTT) were assessed. Correlations between white matter integrity and perfusion changes in watershed regions, as well as the prominence of the brush sign, were evaluated. RESULTS Statistically significant negative correlations between the prominence of the brush sign and the T1w/T2w ratio values from the centrum semiovale and middle frontal white matter were found (R = -0.62 to 0.71, adjusted p < 0.05). Furthermore, there was a positive correlation between the T1w/T2w ratio values and the MTT values from the centrum semiovale (R = 0.65, adjusted p < 0.05). CONCLUSIONS We revealed that T1w/T2w ratio changes are associated with the prominence of the brush sign as well as white matter hypoperfusion in watershed regions in patients with MMA. This could be explained by chronic ischemia due to venous congestion in the deep medullary vein territory.
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Affiliation(s)
- E Filimonova
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia; Novosibirsk State Medical University, Krasny Prospect St. 52, Novosibirsk 630091, Russia.
| | - K Ovsiannikov
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogov Str. 1, Novosibirsk 630090, Russia
| | - B Zaitsev
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia
| | - J Rzaev
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia; Novosibirsk State Medical University, Krasny Prospect St. 52, Novosibirsk 630091, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogov Str. 1, Novosibirsk 630090, Russia
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Lal S, Larney V. Pragmatic anesthetic approach for extracranial to intracranial bypass surgery in a patient with moyamoya disease and sickle cell disease: a case report. J Med Case Rep 2023; 17:136. [PMID: 36998062 PMCID: PMC10064507 DOI: 10.1186/s13256-023-03857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Moyamoya disease is a chronic progressive cerebrovascular disorder. A proportion of 10-20% of patients with sickle cell disease have associated moyamoya disease and may require surgical revascularization as definitive treatment. CASE PRESENTATION A 22-year-old African lady with sickle cell disease and moyamoya disease, with extensive cerebral vasculopathy, was scheduled for elective extracranial to intracranial bypass surgery. She presented with right-sided weakness secondary to a hemorrhagic stroke of the left lentiform nucleus. She required a multidisciplinary team approach for preprocedural optimization. Her preoperative hemoglobin SS levels were reduced to less than 20%, with preoperative red blood cell transfusion to avoid sickling. We maintained normal physiology and optimal analgesia perioperatively. She was extubated after the successful surgical procedure and was transferred to Intensive care unit (ICU) for invasive monitoring, with subsequent discharge to the ward several days later. CONCLUSION Optimal preprocedural optimization can decrease complications in patients with critically comprised cerebral circulation booked for extensive surgery such as ECIC bypass. We believe the presentation of anesthetic management of a patient with moyamoya disease and sickle cell disease may prove helpful.
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Affiliation(s)
- Shankar Lal
- Department of Anaesthesiology and Critical Care Medicine, Beaumont Hospital, Dublin, Republic of Ireland.
| | - Vivienne Larney
- Department of Anaesthesiology and Critical Care Medicine, Beaumont Hospital, Dublin, Republic of Ireland
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Computational Modelling of Cerebral Blood Flow Rate at Different Stages of Moyamoya Disease in Adults and Children. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010077. [PMID: 36671650 PMCID: PMC9854682 DOI: 10.3390/bioengineering10010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Moyamoya disease is a cerebrovascular disorder which causes a decrease in the cerebral blood flow rate. In this study, a lumped parameter model describing the pressures and flow rates in the heart chambers, circulatory system, and cerebral circulation with the main arteries in the circle of Willis, pial circulation, cerebral capillaries, and veins was used to simulate Moyamoya disease with and without coarctation of the aorta in adults and children. Cerebral blood flow rates were 724 mL/min and 1072 mL/min in the healthy adult and child cardiovascular system models. The cerebral blood flow rates in the adult and child cardiovascular system models simulating Moyamoya disease were 676 mL/min and 1007 mL/min in stage 1, 627 mL/min and 892 mL/min in stage 2, 571 mL/min and 831 in stage 3, and 444 and 537 mL/min in stage 4. The cerebral blood flow rates were 926 mL/min and 1421 mL/min in the adult and child cardiovascular system models simulating coarctation of the aorta. Furthermore, the cerebral blood flow rates in the adult and child cardiovascular system model simulating Moyamoya disease with coarctation of the aorta were 867 mL/min and 1341 mL/min in stage 1, 806 mL/min and 1197 mL/min in stage 2, 735 mL/min and 1121 in stage 3, and 576 and 741 mL/min in stage 4. The numerical model utilised in this study can simulate the advancing stages of Moyamoya disease and evaluate the associated risks with Moyamoya disease.
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Ndondo AP, Hammond CK. Management of Pediatric Stroke - Challenges and Perspectives from Resource-limited Settings. Semin Pediatr Neurol 2022; 44:100996. [PMID: 36456038 DOI: 10.1016/j.spen.2022.100996] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
Childhood stroke is not as common as adult stroke, but it is underrecognized the world over. Diagnosis is often delayed due to lack of awareness not only by the lay public but also by emergency and front-line health care workers. Despite the relative rarity of childhood stroke, the impact on morbidity, mortality and the economic burden for families and society is high, especially in poorly resourced settings. The risk factors for stroke in children differ from the adult population where lifestyle factors play a more important role. The developmental aspects of the pediatric cerebral vasculature and hematological maturational biology affects the clinical presentation, investigation, management and outcomes of childhood stroke in a different way compared to adults. The management of childhood stroke is currently based on expert guidelines and evidence extrapolated from adult studies. Hyperacute therapies that have revolutionized the treatment of stroke in adults cannot be easily applied to children at this stage due to the diagnostic delays, diverse risk factors and developmental considerations mentioned above. Much has been achieved in the understanding of genetic, acquired, preventable and recurrent stroke risk factors in the past decade through international collaborative efforts like the International Pediatric Stroke Study. Evidence for the prevention and treatment of childhood stroke remains elusive. Even more elusive are relevant and achievable management guidelines for pediatric stroke in resource-limited settings. This narrative review focusses on the current management practices globally, emphasizing the challenges, and gaps in knowledge of pediatric stroke in low- and middle-income countries and other areas with limited resources. Priorities and some potential solutions at national and local level are suggested for these settings.
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Affiliation(s)
- Alvin Pumelele Ndondo
- Department of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
| | - Charles K Hammond
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Filimonova E, Ovsiannikov K, Sosnov A, Perfilyev A, Gafurov R, Galaktionov D, Bervickiy A, Kiselev V, Rzaev J. Myelin damage and cortical atrophy in watershed regions in patients with moyamoya angiopathy. Front Neurosci 2022; 16:982829. [PMID: 36081657 PMCID: PMC9445365 DOI: 10.3389/fnins.2022.982829] [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] [Received: 06/30/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite it being known that chronic ischemia results in myelin damage and gray matter atrophy, data regarding patients with moyamoya angiopathy is limited. We hypothesized that chronic ischemia in moyamoya angiopathy leads to myelin damage, especially in anterior watershed regions, as well as cortical atrophy in these areas. Materials and methods Twenty adult patients with moyamoya angiopathy and 17 age- and sex-matched healthy controls were evaluated using the T1w/T2w mapping method and surface-based MR-morphometry. The T1w/T2w signal intensity ratio, which reflects the white matter integrity, and the cortical thickness, were calculated in watershed regions and compared between the patients and controls. In the patients with moyamoya angiopathy, the correlations between these parameters and the Suzuki stage were also evaluated. Results The regional T1w/T2w ratio values from centrum semiovale in patients with MMA were significantly lower than those in healthy controls (p < 0.05); there was also a downward trend in T1w/T2w ratio values from middle frontal gyrus white matter in patients compared with the controls (p < 0.1). The cortical thickness of the middle frontal gyrus was significantly lower in patients than in healthy controls (p < 0.05). There were negative correlations between the Suzuki stage and the T1w/T2w ratio values from the centrum semiovale and middle frontal white matter. Conclusion T1w/T2w mapping revealed that myelin damage exists in watershed regions in patients with moyamoya angiopathy, in association with cortical atrophy according to MR-morphometry. These changes were correlated with the disease stage.
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Affiliation(s)
- Elena Filimonova
- Federal Center of Neurosurgery, Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
- *Correspondence: Elena Filimonova,
| | | | | | | | | | - Dmitriy Galaktionov
- Federal Center of Neurosurgery, Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
| | - Anatoliy Bervickiy
- Federal Center of Neurosurgery, Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
| | | | - Jamil Rzaev
- Federal Center of Neurosurgery, Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
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Mills D, Wang A, Dubson I. Vaso-Occlusive Pain Management in a Patient With Sickle Cell Disease Associated With Moyamoya Syndrome. Cureus 2022; 14:e23667. [PMID: 35505700 PMCID: PMC9054428 DOI: 10.7759/cureus.23667] [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: 03/30/2022] [Indexed: 11/15/2022] Open
Abstract
Moyamoya syndrome in a sickle cell disease patient may be a difficult task to manage in the setting of a vaso-occlusive pain crisis. Maintaining stable blood pressure is necessary to prevent stroke as both hypertension and hypotension can be detrimental to the patient, leading to hemorrhagic and ischemic stroke, respectively. Opioid management for pain control in such patients must be taken into consideration. Because every patient is unique, opioid regimens should be optimized to relieve patients’ specific pain while also practicing non-maleficence in preventing hypotension and strokes.
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Lin YH, Huang H, Hwang WZ. Moyamoya disease with Sjogren disease and autoimmune thyroiditis presenting with left intracranial hemorrhage after messenger RNA-1273 vaccination: A case report. Medicine (Baltimore) 2022; 101:e28756. [PMID: 35147099 PMCID: PMC8830843 DOI: 10.1097/md.0000000000028756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/17/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The new vaccines are emergently authorized and currently approved for use to protect against the coronavirus disease 2019 (COVID-19) pandemic and serious adverse events are uncommon. Moyamoya disease (MMD) with autoimmune disease is a rare entity and usually presents with intracranial hemorrhage in adults. PATIENT CONCERNS We reported a 40-year-old female patient with Sjogren disease and autoimmune thyroiditis, who had received the second dose of Moderna (mRNA-1273) vaccination. Three days later, she presented with left intraventricular and intracerebral hemorrhage as a complication. DIAGNOSIS After a series of diagnostic workups, left intracranial hemorrhage was associated with MMD. INTERVENTIONS Emergent external ventricular drainage and subsequent stereotactic evacuation of hematoma with insertion of intracranial pressure monitoring were performed. OUTCOMES Under the care of the neurocritical care team, her physical condition improved gradually. The neurological sequelae was noted by defects of cognitive function, apraxia, agnosia, and impaired executive function. She was discharged after eight weeks with a follow-up in the vascular neurology clinic planning for performing revascularization. LESSONS To the best of our knowledge, no similar case has been reported before, and this is the first case of MMD complicated with intracerebral and intraventricular hemorrhage after mRNA-1273 vaccination. It is noticeable to assess the vaccine safety surveillance and raise the alertness about moyamoya in patients with autoimmune diseases during the COVID-19 pandemic. Further studies for risk evaluation of COVID-19 vaccines in patients with autoimmune diseases might be required in the future.
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Affiliation(s)
- Yi-Hsin Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Hsuan Huang
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wen-Zern Hwang
- Division of Neurosurgery, Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
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Aghoram R. Transcranial color-coded ultrasound for Moyamoya disease-A holistic diagnostic tool? JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:41-42. [PMID: 35043439 DOI: 10.1002/jcu.23099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Rajeswari Aghoram
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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