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Venkatachari M, Ashwanth KS, Samireddypalle Y, Arun Babu T. Moyamoya disease in a 5-year child secondary to MOG antibody-positive cerebral cortical encephalitis. Childs Nerv Syst 2024; 40:2953-2955. [PMID: 38789689 DOI: 10.1007/s00381-024-06470-0] [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: 04/20/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
A 5-year-old girl presented with complaints of fever, left-sided hemiparesis, and left upper motor neuron facial nerve palsy following oral polio booster dose vaccination. She had a past history of fever with altered sensorium with complete resolution at 3 years of age. Cerebrospinal fluid evaluation and stool examination were inconclusive. MRI with MRA showed T2 hyperintensities of the right fronto-temporo-parietal cortex with diffusion restriction and occlusion of bilateral internal carotid arteries and collateral formation suggestive of Moyamoya disease with cerebral cortical encephalitis. Evaluation of encephalitis revealed positivity for anti-myelin oligodendrocyte (MOG) antibodies. She showed a good response to intravenous immunoglobulin and pulse steroids with resolution of encephalitis and facial nerve palsy and improvement in the power of the left side of the body. We presume that the Moyamoya disease in this case is possibly secondary to myelin oligodendrocyte antibody-associated disease.
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Affiliation(s)
- Mahesh Venkatachari
- Dept of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Vijayawada, Andhra Pradesh, India
| | - K S Ashwanth
- Dept of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Vijayawada, Andhra Pradesh, India
| | - Yugandhar Samireddypalle
- Dept of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Vijayawada, Andhra Pradesh, India
| | - Thirunavukkarasu Arun Babu
- Dept of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Vijayawada, Andhra Pradesh, India.
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2
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Santana LS, Leite M, Yoshikawa MH, Santana LS, Larcipretti ALL, Gasparri LG, Diniz JBC, Figueiredo EG, Telles JPM. Evaluation of deep learning algorithms in detecting moyamoya disease: a systematic review and single-arm meta-analysis. Neurosurg Rev 2024; 47:300. [PMID: 38951288 DOI: 10.1007/s10143-024-02537-3] [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: 04/01/2024] [Revised: 06/18/2024] [Accepted: 06/22/2024] [Indexed: 07/03/2024]
Abstract
The diagnosis of Moyamoya disease (MMD) relies heavily on imaging, which could benefit from standardized machine learning tools. This study aims to evaluate the diagnostic efficacy of deep learning (DL) algorithms for MMD by analyzing sensitivity, specificity, and the area under the curve (AUC) compared to expert consensus. We conducted a systematic search of PubMed, Embase, and Web of Science for articles published from inception to February 2024. Eligible studies were required to report diagnostic accuracy metrics such as sensitivity, specificity, and AUC, excluding those not in English or using traditional machine learning methods. Seven studies were included, comprising a sample of 4,416 patients, of whom 1,358 had MMD. The pooled sensitivity for common and random effects models was 0.89 (95% CI: 0.85 to 0.92) and 0.92 (95% CI: 0.85 to 0.96), respectively. The pooled specificity was 0.89 (95% CI: 0.86 to 0.91) in the common effects model and 0.91 (95% CI: 0.75 to 0.97) in the random effects model. Two studies reported the AUC alongside their confidence intervals. A meta-analysis synthesizing these findings aggregated a mean AUC of 0.94 (95% CI: 0.92 to 0.96) for common effects and 0.89 (95% CI: 0.76 to 1.02) for random effects models. Deep learning models significantly enhance the diagnosis of MMD by efficiently extracting and identifying complex image patterns with high sensitivity and specificity. Trial registration: CRD42024524998 https://www.crd.york.ac.uk/prospero/displayrecord.php?RecordID=524998.
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Affiliation(s)
| | | | | | | | | | | | - Jordana Borges Camargo Diniz
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Eberval Gadelha Figueiredo
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - João Paulo Mota Telles
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil.
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3
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Rao VL, Shin JW, Klaas JP, Lanzino G. Concurrent Moyamoya-like Intracranial Steno-Occlusive Disease and Dural Arteriovenous Fistulas. AJNR Am J Neuroradiol 2024; 45:708-711. [PMID: 38697786 PMCID: PMC11288610 DOI: 10.3174/ajnr.a8197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/15/2024] [Indexed: 05/05/2024]
Abstract
The simultaneous presentation of intracranial steno-occlusive disease, Moyamoya disease, or Moyamoya-like vasculopathy and dural arteriovenous fistulas (DAVFs) has been documented in very few case reports worldwide. We aimed to better characterize this association by reviewing the clinical and radiologic findings of 4 patients with concurrent intracranial steno-occlusive disease or Moyamoya-like vasculopathy and DAVFs evaluated in our institution. All 4 patients were of Asian descent. One patient presented with ischemic stroke secondary to intracranial stenosis, 2 presented with symptoms related to the DAVF, and the diagnosis was incidental in the fourth patient. Three patients underwent embolization of the DAVF, which was followed by surgical ligation in 2. One patient underwent extracranial-intracranial bypass for Moyamoya-like intracranial steno-occlusive disease. One patient is being managed conservatively with close follow-up. Our case series details findings in 4 patients with associated intracranial steno-occlusive disease and DAVFs. Further studies and reporting of similar cases are necessary to establish whether this is pure coincidence or if there is indeed a relationship between these 2 conditions, especially in certain ethnic groups.
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Affiliation(s)
- Vaishnavi L Rao
- From the Department of Neurosurgery (V.L.R., G.L.), Mayo Clinic, Rochester, Minnesota
| | - Jee Won Shin
- Mayo Clinic Alix School of Medicine (J.W.S.), Rochester, Minnesota
| | - James P Klaas
- Department of Neurology (J.P.K.), Mayo Clinic, Rochester, Minnesota
| | - Giuseppe Lanzino
- From the Department of Neurosurgery (V.L.R., G.L.), Mayo Clinic, Rochester, Minnesota
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4
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He Q, Li J, Tao C, Zeng C, Liu C, Zheng Z, Mou S, Liu W, Zhang B, Yu X, Zhai Y, Wang J, Zhang Q, Zhang Y, Zhang D, Zhao J, Ge P. High glutamine increases stroke risk by inducing the endothelial-to-mesenchymal transition in moyamoya disease. MedComm (Beijing) 2024; 5:e525. [PMID: 38628905 PMCID: PMC11018113 DOI: 10.1002/mco2.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 02/04/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
At present, there is limited research on the mechanisms underlying moyamoya disease (MMD). Herein, we aimed to determine the role of glutamine in MMD pathogenesis, and 360 adult patients were prospectively enrolled. Human brain microvascular endothelial cells (HBMECs) were subjected to Integrin Subunit Beta 4 (ITGB4) overexpression or knockdown and atorvastatin. We assessed factors associated with various signaling pathways in the context of the endothelial-to-mesenchymal transition (EndMT), and the expression level of related proteins was validated in the superficial temporal arteries of patients. We found glutamine levels were positively associated with a greater risk of stroke (OR = 1.599, p = 0.022). After treatment with glutamine, HBMECs exhibited enhanced proliferation, migration, and EndMT, all reversed by ITGB4 knockdown. In ITGB4-transfected HBMECs, the MAPK-ERK-TGF-β/BMP pathway was activated, with Smad4 knockdown reversing the EndMT. Furthermore, atorvastatin suppressed the EndMT by inhibiting Smad1/5 phosphorylation and promoting Smad4 ubiquitination in ITGB4-transfected HBMECs. We also found the protein level of ITGB4 was upregulated in the superficial temporal arteries of patients with MMD. In conclusion, our study suggests that glutamine may be an independent risk factor for hemorrhage or infarction in patients with MMD and targeting ITGB4 could potentially be therapeutic approaches for MMD.
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Affiliation(s)
- Qiheng He
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Junsheng Li
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Chuming Tao
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Chaofan Zeng
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Chenglong Liu
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Zhiyao Zheng
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Research Unit of Accurate Diagnosis, Treatment, and Translational Medicine of Brain TumorsChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of NeurosurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Siqi Mou
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Wei Liu
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Bojian Zhang
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xiaofan Yu
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yuanren Zhai
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Jia Wang
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- 3D Printing Center in Clinical NeuroscienceChina National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Qian Zhang
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yan Zhang
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Dong Zhang
- Department of NeurosurgeryBeijing HospitalBeijingChina
| | - Jizong Zhao
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- 3D Printing Center in Clinical NeuroscienceChina National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Peicong Ge
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
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Ran KR, Nair SK, Srinivas T, Xie ME, Kilgore CB, Ye X, Yedavalli VS, Sun LR, Jackson CM, Caplan JM, Gonzalez LF, Tamargo RJ, Huang J, Xu R. Hemoglobin Drop is Associated with Early Post-operative Stroke Following Revascularization Surgery for Moyamoya Disease. J Neurosurg Anesthesiol 2024:00008506-990000000-00109. [PMID: 38686811 DOI: 10.1097/ana.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Postoperative stroke is a potentially devastating neurological complication following surgical revascularization for Moyamoya disease. We sought to evaluate whether peri-operative hemoglobin levels were associated with the risk of early post-operative stroke following revascularization surgery in adult Moyamoya patients. METHODS Adult patients having revascularization surgeries for Moyamoya disease between 1999-2022 were identified through single institutional retrospective review. Logistic regression analysis was used to test for the association between hemoglobin drop and early postoperative stroke. RESULTS In all, 106 revascularization surgeries were included in the study. A stroke occurred within 7 days after surgery in 9.4% of cases. There were no significant associations between the occurrence of an early postoperative stroke and patient age, gender, or race. Mean postoperative hemoglobin drop was greater in patients who suffered an early postoperative stroke compared with patients who did not (2.3±1.1 g/dL vs. 1.3±1.1 g/dL, respectively; P=0.034). Patients who experienced a hemoglobin drop post-operatively had 2.03 times greater odds (95% confidence interval, 1.06-4.23; P=0.040) of having a stroke than those whose hemoglobin levels were stable. Early postoperative stroke was also associated with an increase in length of hospital stay (P<0.001), discharge to a rehabilitation facility (P=0.014), and worse modified Rankin scale at 1 month (P=0.001). CONCLUSION This study found a significant association between hemoglobin drop and early postoperative stroke following revascularization surgery in adult patients with Moyamoya disease. Based on our findings, it may be prudent to avoid hemoglobin drops in Moyamoya patients undergoing surgical revascularization.
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Affiliation(s)
| | | | | | | | | | | | | | - Lisa R Sun
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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Yang H, Huang G, Li X, Wu M, Zhou W, Yin X, Zhang M, Chen Z. High-resolution magnetic resonance vessel wall imaging provides new insights into Moyamoya disease. Front Neurosci 2024; 18:1375645. [PMID: 38665292 PMCID: PMC11043609 DOI: 10.3389/fnins.2024.1375645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/13/2024] [Indexed: 04/28/2024] Open
Abstract
Moyamoya disease (MMD) is a rare condition that affects the blood vessels of the central nervous system. This cerebrovascular disease is characterized by progressive narrowing and blockage of the internal carotid, middle cerebral, and anterior cerebral arteries, which results in the formation of a compensatory fragile vascular network. Currently, digital subtraction angiography (DSA) is considered the gold standard in diagnosing MMD. However, this diagnostic technique is invasive and may not be suitable for all patients. Hence, non-invasive imaging methods such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are often used. However, these methods may have less reliable diagnostic results. Therefore, High-Resolution Magnetic Resonance Vessel Wall Imaging (HR-VWI) has emerged as the most accurate method for observing and analyzing arterial wall structure. It enhances the resolution of arterial walls and enables quantitative and qualitative analysis of plaque, facilitating the identification of atherosclerotic lesions, vascular entrapment, myofibrillar dysplasia, moyamoya vasculopathy, and other related conditions. Consequently, HR-VWI provides a new and more reliable evaluation criterion for diagnosing vascular lesions in patients with Moyamoya disease.
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Affiliation(s)
- Hui Yang
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
- School of Basic Medicine, Jiujiang University, Jiujiang, China
| | - Guilan Huang
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Xi Li
- Department of Neurology, University of California Irvine Medical Center, Irvine, CA, United States
| | - Moxin Wu
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Weixin Zhou
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Xiaoping Yin
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Manqing Zhang
- School of Basic Medicine, Jiujiang University, Jiujiang, China
| | - Zhiying Chen
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
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Ullah R, Al Balushi J, Nishat N, Mughal HMF, Misra G, Shehriyar. Moyamoya Disease with Non-Functional Pituitary Macroadenoma: A Case Report of a Rare Presentation. Cureus 2024; 16:e56728. [PMID: 38650810 PMCID: PMC11034900 DOI: 10.7759/cureus.56728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Moyamoya disease (MMD) is a rare neurological condition characterized by brain blood vessel narrowing, leading to collateral vessel formation. Diagnosis typically involves cerebral angiography and magnetic resonance angiography (MRA), with surgical revascularization often providing superior outcomes. Here, we present the case of a 55-year-old woman with hypertension, diabetes, and a history of ischemic stroke. She recently experienced a hemorrhagic stroke due to MMD, compounded by a non-functional pituitary macroadenoma. Recognizing signs of a hemorrhagic stroke is crucial to prevent future occurrences and ensure optimal outcomes. However, our understanding of the connection between MMD and pituitary macroadenoma remains incomplete. Further research is essential to refine diagnostic techniques and treatment strategies. Through continued research and awareness, we can strive for improved outcomes and an enhanced quality of life for individuals affected by MMD and its complications.
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Affiliation(s)
- Rizwan Ullah
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
| | | | - Nadia Nishat
- Family Medicine, Adichunchanagiri Institute of Medical Sciences, Mandya, IND
| | | | - Gayatri Misra
- Medicine, American University of Antigua, Osbourn, USA
| | - Shehriyar
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
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Soler-Rico M, Di Santo M, Vaz G, Joris V, Fomekong E, Guillaume S, Van Boven M, Raftopoulos C. How to reduce the complication rate of multiple burr holes surgery in moyamoya angiopathy. Acta Neurochir (Wien) 2023; 165:3613-3622. [PMID: 37993630 DOI: 10.1007/s00701-023-05876-0] [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: 07/18/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE This study is aimed at analyzing clinical outcome, absence of stroke recurrence, revascularization, and complications and long-term follow-up in the surgical treatment of moyamoya angiopathy (MMA) using the multiple burr holes (MBH) technique with dura opening and arachnoid preservation as a single procedure. To the best of our knowledge, this is the first to describe an MBH technique with arachnoid preservation. METHOD We retrospectively reviewed all patients operated from June 2001 to March 2021, for a symptomatic and progressive MMA operated with opening of the dura but arachnoid preservation. Clinical examinations were obtained in all patients, and radiological monitoring was performed by cerebral 3D-magnetic resonance angiography (MRA) with perfusion or single-photon emission computed tomography (SPECT) with acetazolamide. RESULTS In total, 21 consecutive patients (6 children and 15 adults) were included with a mean age of 7.4 years in the pediatric group and 36.9 years in the adult group. Initial presentation was permanent ischemic stroke in 15 cases, transient ischemic attack (TIA) in 5 cases, and cerebral hemorrhage in one case. The MBH with dura opening and arachnoid preservation was performed bilaterally in 9 cases (43%) and unilaterally in 12 cases (57%). One patient died due to intraoperative bilateral ischemic stroke. Of the 20 other patients, 30% demonstrated clinical stability and 70% showed partial or complete recovery. Although one patient experienced a perioperative stroke, we did not observe any pseudomeningocele or postoperative ischemic stroke (IS) recurrence in all surviving cases during the average follow-up period of 55.5 months (range: 1-195). These outcomes emphasize the importance of preoperative monitoring to ensure the effectiveness and safety of the intervention. Postoperative angiography studies showed revascularization in 96.3% of treated hemispheres (100% in the adult group vs 80% in the pediatric group). CONCLUSIONS Our results on this small cohort suggest that the MBH technique with opening of the dura and arachnoids preservation can prevent recurrent strokes and reduce the risk of pseudomeningocele.
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Affiliation(s)
- M Soler-Rico
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - M Di Santo
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - G Vaz
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - V Joris
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - E Fomekong
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - S Guillaume
- Medical Imaging Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - M Van Boven
- Anesthesiology Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - C Raftopoulos
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Ayub Jajja S, Kunwar D, Ahmed S, Akbar A, Anjum AS, Anjum S. Moyamoya disease in an adolescent with subarachnoid hemorrhage: a case report. Int J Neurosci 2023:1-5. [PMID: 37996399 DOI: 10.1080/00207454.2023.2287980] [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: 05/17/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE/AIM OF THE STUDY This study aims to present a case of Moyamoya disease (MMD) in an adolescent who experienced a subarachnoid hemorrhage (SAH). The purpose is to underscore the importance of considering MMD as a potential cause of SAH in adolescents, particularly in the absence of common causes such as trauma or aneurysmal rupture. The case further highlights the significance of early identification and appropriate management to prevent further complications and improve patient outcomes. MATERIALS AND METHODS The diagnosis was initially based on findings from a CT angiography and later confirmed through magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI). RESULTS The case study demonstrates the effectiveness of utilizing MRA and MRI in diagnosing MMD in adolescents. It emphasizes the challenges in areas with limited resources where advanced imaging techniques like digital subtraction angiography (DSA) may not be readily accessible or affordable. The gold standard for MMD diagnosis, DSA, is acknowledged, but the study underscores the importance of alternative imaging methods in resource-constrained settings. CONCLUSION In conclusion, this case underscores the importance of considering Moyamoya disease as a potential etiology for subarachnoid hemorrhage in adolescents, particularly when common causes are absent. The study highlights the crucial role of MRA and MRI in the diagnosis of MMD, emphasizing their significance in areas with limited resources. Early identification and appropriate management are essential for preventing complications and improving patient outcomes, acknowledging the challenges associated with the accessibility of gold standard diagnostic techniques in certain settings.
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Affiliation(s)
| | - Digbijay Kunwar
- Internal Medicine, Nishtar Medical University, Multan, Pakistan
| | - Shahroze Ahmed
- Internal Medicine, Nishtar Medical University, Multan, Pakistan
| | - Anum Akbar
- Department of Pediatrics, University of Nebraska Medical Center, Nebraska, USA
| | | | - Sadia Anjum
- Radiology, Nishtar Medical University, Multan, Pakistan
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Ott WP, Bellamy S, Onyali CB. A Rare Case of Moyamoya Disease in a Hispanic Woman: Unveiling Non-Asian Ethnicity and Atypical Risk Factors. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e940353. [PMID: 37528569 PMCID: PMC10405348 DOI: 10.12659/ajcr.940353] [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: 03/14/2023] [Revised: 06/28/2023] [Accepted: 06/07/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Moyamoya disease is a rare and progressive cerebrovascular disorder caused by narrowed or blocked arteries supplying the brain. First described in Japan, the disease's incidence is higher in Asian countries and primarily affects children, although adults can also be afflicted. Following a literature review, very little was found regarding non-Asian ethnicities and the lack of typically associated risk factors that are known correlates of Moyamoya disease. CASE REPORT We present the case of a 41-year-old Hispanic woman with a history of type 1 diabetes mellitus and asthma who presented to the Emergency Department with concerns of recurrent transient episodes of left upper extremity weakness and paresthesia followed by confusion. The patient's blood pressure on arrival was 215/134 mmHg, and heart rate was 124 beats per min. Computed tomography of the head was unremarkable, but a computed tomography angiogram of the head demonstrated several areas of severe and bilateral stenosis with radiographic appearances, suggestive of Moyamoya disease. Magnetic resonance imaging of the brain would later illustrate two 6×2-mm ischemic infarcts in the right posterior centrum semiovale. CONCLUSIONS Moyamoya disease in the non-Asian population is rarely reported. We present a case of this condition in a patient of Hispanic ethnicity. Although it is generally considered a non-atherosclerotic disease, some literature suggests that atherosclerotic disease may also contribute to the development and possible acceleration of clinical features of Moyamoya disease. Given our patient's risk factors, we postulated that our patient's presentation was likely multifactorial, with both non-sclerotic and atherosclerotic disease.
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11
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Zhang XH, He JH, Zhang XS, Zhang J, Wang CJ, Dong YP, Tao W. Comparison of revascularization and conservative treatment for hemorrhagic moyamoya disease in East Asian Countries: a single-center case series and a systematic review with meta-analysis. Front Neurol 2023; 14:1169440. [PMID: 37332987 PMCID: PMC10272728 DOI: 10.3389/fneur.2023.1169440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/28/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The optimal treatment approach for hemorrhagic moyamoya disease (HMMD) remains a topic of debate, particularly regarding the comparative efficacy of revascularization versus conservative treatment. Our study, which included a single-center case series and a systematic review with meta-analysis, aimed to determine whether surgical revascularization is associated with a significant reduction in postoperative rebleeding, ischemic events, and mortality compared to conservative treatment among East Asian HMMD patients. Methods We conducted a systematic literature review by searching PubMed, Google Scholar, Wanfang Med Online (WMO), and the China National Knowledge Infrastructure (CNKI). The outcomes of surgical revascularization and conservative treatment, including rebleeding, ischemic events and mortality, were compared. The authors' institutional series of 24 patients were also included and reviewed in the analysis. Results A total of 19 East Asian studies involving 1,571 patients as well as our institution's retrospective study of 24 patients were included in the study. In the adult patients-only studies, those who underwent revascularization had significantly lower rates of rebleeding, ischemic events, and mortality compared to those who received conservative treatment (13.1% (46/352) vs. 32.4% (82/253), P < 0.00001; 4.0% (5/124) vs. 14.9% (18/121), P = 0.007; and 3.3% (5/153) vs. 12.6% (12/95), P = 0.01, respectively). In the adult/pediatric patients' studies, similar statistical results of rebleeding, ischemic events, and mortality have been obtained (70/588 (11.9%) vs. 103/402 (25.6%), P = 0.003 or <0.0001 in a random or fixed-effects model, respectively; 14/296 (4.7%) vs. 26/183 (14.2%), P = 0.001; and 4.6% (15/328) vs. 18.7% (23/123), P = 0.0001, respectively). Conclusion The current single-center case series and systematic review with meta-analysis of studies demonstrated that surgical revascularization, including direct, indirect, and a combination of both, significantly reduces rebleeding, ischemic events, and mortality in HMMD patients in the East Asia region. More well-designed studies are warranted to further confirm these findings.
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Affiliation(s)
- Xiang-Hua Zhang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Jun-Hua He
- Department of Neurosurgery, Zhejiang Provincial Tongde Hospital, Hangzhou, China
| | - Xiang-Sheng Zhang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Cheng-jun Wang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Yi-Peng Dong
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Wu Tao
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
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Yadav R, Pokhriyal SC, Yadav V, Idries I, Berekashvili K, Panigrahi K, Wasifuddin M. The Role of Dual Antiplatelet Therapy (DAPT) vs Surgery in a Case of Moyamoya Disease: A Case Report and Review of the Literature. Cureus 2023; 15:e39694. [PMID: 37398791 PMCID: PMC10308803 DOI: 10.7759/cureus.39694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by non-atherosclerotic and non-inflammatory progressive narrowing of the intracranial part of the carotid artery and its proximal branches. The disease process is commonly associated with the development of weak, dilated collateral blood vessels at the base of the brain. This gives it a classic smoky appearance on cerebral angiograms and hence the name "Moyamoya" which means "puff of smoke" in Japanese. When a patient has similar vasculopathy in the setting of another disease then it is known as Moyamoya syndrome (MMS). The associated diseases are sickle cell anemia, neurofibromatosis, long-standing diabetes, uncontrolled hypertension, or chemotherapy. Despite being known as a disease of the East Asian population, the disease is no longer exclusive to Asians, as evidenced by the rising incidence among non-Asian groups such as Caucasians, Hispanics, and African Americans. Patients can remain asymptomatic or present with ischemic or hemorrhagic stroke, headache, seizures, or recurrent transient ischemic attacks. Conventional cerebral angiography is considered the gold standard for diagnosing MMD. Treatment may be supportive, medical, or surgical. We present the case of a 42-year-old African American woman with several comorbidities who presented with sudden onset of ischemic stroke and upon further workup was found to have MMD. Equally important is to identify the most effective therapeutic approaches based on individual patients to achieve better clinical outcomes. Our case report highlights the importance of surgery in symptomatic MMD with a lack of supporting evidence indicating the benefits of dual antiplatelet therapy (DAPT).
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Affiliation(s)
- Ruchi Yadav
- Hematology and Oncology, Brookdale University Hospital Medical Center, New York, USA
| | | | - Vivek Yadav
- Pulmonary and Critical Care, State University of New York Downstate Health Sciences University, New York, USA
| | - Iyad Idries
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | | | | | - Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
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Gan L, Yin X, Huang J, Jia B. Transcranial Doppler analysis based on computer and artificial intelligence for acute cerebrovascular disease. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:1695-1715. [PMID: 36899504 DOI: 10.3934/mbe.2023077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Cerebrovascular disease refers to damage to brain tissue caused by impaired intracranial blood circulation. It usually presents clinically as an acute nonfatal event and is characterized by high morbidity, disability, and mortality. Transcranial Doppler (TCD) ultrasonography is a non-invasive method for the diagnosis of cerebrovascular disease that uses the Doppler effect to detect the hemodynamic and physiological parameters of the major intracranial basilar arteries. It can provide important hemodynamic information that cannot be measured by other diagnostic imaging techniques for cerebrovascular disease. And the result parameters of TCD ultrasonography such as blood flow velocity and beat index can reflect the type of cerebrovascular disease and serve as a basis to assist physicians in the treatment of cerebrovascular diseases. Artificial intelligence (AI) is a branch of computer science which is used in a wide range of applications in agriculture, communications, medicine, finance, and other fields. In recent years, there are much research devoted to the application of AI to TCD. The review and summary of related technologies is an important work to promote the development of this field, which can provide an intuitive technical summary for future researchers. In this paper, we first review the development, principles, and applications of TCD ultrasonography and other related knowledge, and briefly introduce the development of AI in the field of medicine and emergency medicine. Finally, we summarize in detail the applications and advantages of AI technology in TCD ultrasonography including the establishment of an examination system combining brain computer interface (BCI) and TCD ultrasonography, the classification and noise cancellation of TCD ultrasonography signals using AI algorithms, and the use of intelligent robots to assist physicians in TCD ultrasonography and discuss the prospects for the development of AI in TCD ultrasonography.
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Affiliation(s)
- Lingli Gan
- Department of Neurology, Chongqing General Hospital, Chongqing 401147, China
| | - Xiaoling Yin
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, China
| | - Jiating Huang
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
| | - Bin Jia
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, China
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Mertens R, Acker G, Kersting K, Lange C, Furth C, Beyaztas D, Truckenmueller P, Moedl L, Spruenken ED, Czabanka M, Vajkoczy P. Validation of the Berlin Grading System for moyamoya angiopathy with the use of [ 15O]H 2O PET. Neurosurg Rev 2022; 46:25. [PMID: 36574089 PMCID: PMC9794537 DOI: 10.1007/s10143-022-01920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/05/2022] [Accepted: 11/30/2022] [Indexed: 12/28/2022]
Abstract
The Berlin Grading System assesses clinical severity of moyamoya angiopathy (MMA) by combining MRI, DSA, and cerebrovascular reserve capacity (CVRC). Our aim was to validate this grading system using [15O]H2O PET for CVRC. We retrospectively identified bilateral MMA patients who underwent [15O]H2O PET examination and were treated surgically at our department. Each hemisphere was classified using the Suzuki and Berlin Grading System. Preoperative symptoms and perioperative ischemias were collected, and a logistic regression analysis was performed. A total of 100 hemispheres in 50 MMA patients (36 women, 14 men) were included. Using the Berlin Grading System, 2 (2.8%) of 71 symptomatic hemispheres were categorized as grade I, 14 (19.7%) as grade II, and 55 (77.5%) as grade III. The 29 asymptomatic hemispheres were characterized as grade I in 7 (24.1%) hemispheres, grade II in 12 (41.4%), and grade III in 10 (34.5%) hemispheres. Berlin grades were independent factors for identifying hemispheres as symptomatic and higher grades correlated with increasing proportion of symptomatic hemispheres (p < 0.01). The Suzuki grading did not correlate with preoperative symptoms (p = 0.26). Perioperative ischemic complications occurred in 8 of 88 operated hemispheres. Overall, complications did not occur in any of the grade I hemispheres, but in 9.1% (n = 2 of 22) and 9.8% (n = 6 of 61) of grade II and III hemispheres, respectively. In this study, we validated the Berlin Grading System with the use of [15O]H2O PET for CVRC as it could stratify preoperative symptomatology. Furthermore, we highlighted its relevance for predicting perioperative ischemic complications.
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Affiliation(s)
- R Mertens
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Kersting
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C Lange
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C Furth
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - D Beyaztas
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - P Truckenmueller
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - L Moedl
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - E D Spruenken
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - M Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - P Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
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Almutairi OK, Abdulmoez Y. Case report: Moyamoya disease, the culprit in an adult female presenting with left sided numbness. Medicine (Baltimore) 2022; 101:e32160. [PMID: 36482624 PMCID: PMC9726383 DOI: 10.1097/md.0000000000032160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Moyamoya disease is a rare progressive cerebrovascular disease that is characterized by stenosis of the vascular branches of the internal carotid artery and the development of abnormal, fragile collateral vessels. Patients with Moyamoya disease mainly present with signs and symptoms of cerebral ischemia or cerebral hemorrhage with a typically progressive course. PATIENT CONCERNS Here, we present a case of an adult female presenting with left sided upper and lower limb numbness. DIAGNOSES Diagnosis is through cerebral angiographic images demonstrating the characteristic look of collateral vessels classically present in Moyamoya disease. In this case, initial angiographic imaging along with high-resolution vessel wall brain magnetic imaging were used to diagnose the patient with this disease. INTERVENTIONS The patient was advised for surgical intervention; however, they were reluctant. OUTCOMES The patient was treated conservatively and advised for follow-up. LESSONS This case highlights the importance of considering Moyamoya disease in the differential diagnosis of patients presenting with sudden neurological symptoms. High-resolution vessel wall MRI is a useful tool to diagnose this disease.
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Affiliation(s)
- Ohood Kh. Almutairi
- Neurology resident, Kuwait Institute for Medical Specializations, Kuwait
- * Correspondence: Ohood Kh. Almutairi, Neurology resident, Kuwait Institute for Medical Specializations, Kuwait (e-mail: )
| | - Yasser Abdulmoez
- Consultant of Internal Medicine, Internal medicine department, Farwaniya hospital, Kuwait
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Liu E, Zhao H, Liu C, Tan X, Luo C, Yang S. Research progress of moyamoya disease combined with renovascular hypertension. Front Surg 2022; 9:969090. [PMID: 36090342 PMCID: PMC9458923 DOI: 10.3389/fsurg.2022.969090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Erheng Liu
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Heng Zhao
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Chengyuan Liu
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Xueyi Tan
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Chao Luo
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Shuaifeng Yang
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
- Correspondence: Shuaifeng Yang
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Chavan G, Chavan A, Nagdev G, Aurangabadkar GM. Moyamoya Disease From an Otolaryngologist’s Perspective: A Rare Case. Cureus 2022; 14:e28108. [PMID: 36127999 PMCID: PMC9480859 DOI: 10.7759/cureus.28108] [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: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
Moyamoya disease is characterized by narrowing of cerebral blood vessels and is progressive in nature. We present the case of a 21-year-old female patient who was a known case of Down’s syndrome and presented with right-sided facial muscle weakness and was initially suspected of having cholesteatoma, but no evidence for the same was found after extensive radiological investigations. The suspicion of a central nervous system pathology was raised due to the clinical findings of dysphasia and supranuclear facial palsy. Magnetic-resonance angiography (MRA) was suggestive of findings of early Moyamoya disease. After a Neurologist consultation, the patient was started on conservative management with anti-platelet drugs and Statins and had symptomatic improvement. The patient was advised regular follow-up and had no fresh episodes of similar complaints.
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18
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Zhu J, Zhang M, Sun Y, Zhang X. Moyamoya syndrome with ruptured aneurysm in α‑thalassemia: A case report. Exp Ther Med 2022; 24:556. [PMID: 35978939 PMCID: PMC9366260 DOI: 10.3892/etm.2022.11494] [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: 05/10/2022] [Accepted: 06/22/2022] [Indexed: 12/03/2022] Open
Abstract
Moyamoya syndrome (MMS) refers to the moyamoya vascular disease associated with various systemic diseases and conditions, including sickle cell anemia, Fanconi anemia and iron deficiency anemia. However, the association between MMS and other hemoglobinopathies is less frequently observed. MMS, like moyamoya disease, is a cerebrovascular condition that is characterized by chronic progressive stenosis or occlusion at the ends of the bilateral internal carotid arteries, anterior cerebral arteries and the beginning of the middle cerebral arteries, and is secondary to the formation of an abnormal vascular network at the base of the skull. Patients with MMS are prone to thrombosis, aneurysm and bleeding. The present study reports the case of a 43-year-old man with α-thalassemia who presented with moyamoya vessels with a ruptured aneurysm bleeding into the ventricle. α-thalassemia is considered as an extremely rare but potential cause of MMS. Since MMS is a progressive disease, early diagnosis and treatment is vital to prevent the disease from worsening.
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Affiliation(s)
- Jiabin Zhu
- Department of Neurosurgery, Affiliated Xiaolan Hospital, Southern Medical University, Xiaolan People's Hospital of Zhongshan, Zhongshan, Guangdong 528415, P.R. China
| | - Mingwen Zhang
- Department of Neurosurgery, Affiliated Xiaolan Hospital, Southern Medical University, Xiaolan People's Hospital of Zhongshan, Zhongshan, Guangdong 528415, P.R. China
| | - Yichun Sun
- Department of Neurosurgery, Affiliated Xiaolan Hospital, Southern Medical University, Xiaolan People's Hospital of Zhongshan, Zhongshan, Guangdong 528415, P.R. China
| | - Xiaofeng Zhang
- Department of Neurosurgery, Affiliated Xiaolan Hospital, Southern Medical University, Xiaolan People's Hospital of Zhongshan, Zhongshan, Guangdong 528415, P.R. China
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Jeong Y, Jung YJ, Noh E, Ha S, Hwang J, Cho GJ, Oh MJ, Kim YH. The risk for future cerebrovascular disease in pregnant women with Moyamoya disease: a nationwide population-based study in South Korea. BMC Pregnancy Childbirth 2022; 22:433. [PMID: 35610618 PMCID: PMC9128146 DOI: 10.1186/s12884-022-04718-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 04/22/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Physiologic changes during pregnancy affect the development of postpartum cerebrovascular disease (CVD) in women with Moyamoya disease. Due to the rare prevalence of Moyamoya disease and its large regional variations, large-scale based studies on the risk of CVD after delivery have not been conducted. This study aimed to evaluate whether women with Moyamoya disease have an increased risk of CVD after delivery. METHODS Research data was collected from the National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients who delivered in Korea from 2007 to 2014 were enrolled in this study. We classified women as having CVD if they were diagnosed with any of the following conditions between delivery and December 31, 2016; cerebral infarction (I63.X in the International Classification of Diseases-10th Revision [ICD-10]) and/or intracranial hemorrhage (I61.X, I62.X in ICD-10) and/or subarachnoid hemorrhage (I60.X in ICD-10). Women with Moyamoya disease were identified as having I67.5 in ICD-10. We matched the study cohort by the ratio of 1:10 to analyze the risk CVD occurrence. The matching technique applied in this study was based on the variables of age and parity. To evaluate the adjusted hazard ratio (HR) for CVD in women with Moyamoya disease, we used multivariate Cox proportional hazard regression. RESULTS Among a total of 3,611,216 Korean women who underwent delivered, we identified 412 women with Moyamoya disease diagnosis and 1420 age- and parity-matched women without Moyamoya disease (control). Compared to the control group, women with Moyamoya disease had a significantly higher rate of Cesarean section, overt DM, and essential hypertension (all p < 0.0001). Among women with Moyamoya disease, 55 (13.35%) women developed CVD within the follow-up postpartum period. The presence of Moyamoya disease was associated with an increased risk of CVD after delivery (adjusted HR 37.42; 95% confidence interval (CI) 17.50-80.02 within 2.3 years) after adjusting for pregnancy-induced hypertension, gestational diabetes mellitus, pregestational diabetes, chronic hypertension. CONCLUSION This population based study showed that the occurrence rate of CVD after delivery was higher in women with Moyamoya disease than in those without. Therefore, careful and long-term postpartum surveillance is required for women with Moyamoya disease.
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Affiliation(s)
- Yeonseong Jeong
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Yun Ji Jung
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Eunjin Noh
- Korea University Guro Hospital Smart Healthcare Center, Seoul, Republic of Korea
| | - Sungyeon Ha
- Graduate School of Statistics, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jeongeun Hwang
- Department of Biomedical Research Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Han Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
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Hu J, Li Y, Li Z, Chen J, Cao Y, Xu D, Zheng L, Bai R, Wang L. Abnormal brain functional and structural connectivity between the left supplementary motor area and inferior frontal gyrus in moyamoya disease. BMC Neurol 2022; 22:179. [PMID: 35578209 PMCID: PMC9108139 DOI: 10.1186/s12883-022-02705-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disruption of brain functional connectivity has been detected after stroke, but whether it also occurs in moyamoya disease (MMD) is unknown. Impaired functional connectivity is always correlated with abnormal white matter fibers. Herein, we used multimodal imaging techniques to explore the changes in brain functional and structural connectivity in MMD patients. METHODS We collected structural images, resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging for each subject. Cognitive functions of MMD patients were evaluated using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Trail Making Test parts A and B (TMT-A/-B). We calculated the functional connectivity for every paired region using 90 regions of interest from the Anatomical Automatic Labeling Atlas and then determined the differences between MMD patients and HCs. We extracted the functional connectivity of paired brain regions with significant differences between the two groups. Correlation analyses were then performed between the functional connectivity and variable cognitive functions. To explore whether the impaired functional connectivity and cognitive performances were attributed to the destruction of white matter fibers, we further analyzed fiber integrity using tractography between paired regions that were correlated with cognition. RESULTS There was lower functional connectivity in MMD patients as compared to HCs between the bilateral inferior frontal gyrus, between the bilateral supramarginal gyrus, between the left supplementary motor area (SMA) and the left orbital part of the inferior frontal gyrus (IFGorb), and between the left SMA and the left middle temporal gyrus (P < 0.01, FDR corrected). The decreased functional connectivity between the left SMA and the left IFGorb was significantly correlated with the MMSE (r = 0.52, P = 0.024), MoCA (r = 0.60, P = 0.006), and TMT-B (r = -0.54, P = 0.048) in MMD patients. White matter fibers were also injured between the SMA and IFGorb in the left hemisphere and were positively correlated with reduced functional connectivity. CONCLUSIONS Brain functional and structural connectivity between the supplementary motor area and inferior frontal gyrus in the left hemisphere are damaged in MMD. These findings could be useful in the evaluation of disease progression and prognosis of MMD.
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Affiliation(s)
- Junwen Hu
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88th, Hangzhou, 310009, China
| | - Yin Li
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88th, Hangzhou, 310009, China
| | - Zhaoqing Li
- Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrument Science, Zhejiang University, 268 Kaixuan Road, South Central Building, Room 708, Hangzhou, 310027, Zhejiang, China
| | - Jingyin Chen
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88th, Hangzhou, 310009, China
| | - Yang Cao
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88th, Hangzhou, 310009, China
| | - Duo Xu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Leilei Zheng
- Department of Psychiatry, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ruiliang Bai
- Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrument Science, Zhejiang University, 268 Kaixuan Road, South Central Building, Room 708, Hangzhou, 310027, Zhejiang, China. .,Department of Physical Medicine and Rehabilitation of the Affiliated Sir Run Run Shaw Hospital and Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, China. .,MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China.
| | - Lin Wang
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88th, Hangzhou, 310009, China.
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Das S, Dubey S, Das S, Hazra A, Pandit A, Ghosh R, Ray BK. Epidemiology of Moyamoya Angiopathy in Eastern India. Front Neurol 2022; 13:837704. [PMID: 35309562 PMCID: PMC8931392 DOI: 10.3389/fneur.2022.837704] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Moyamoya angiopathy (MMA) is a chronic, progressive intracranial vasculopathy with variation in prevalence and clinical manifestations across different populations. This study was aimed to estimate the frequency of MMA as an etiology of stroke and its epidemiological features in the largest cohort of MMA patients in India. Method A single-centered cross-sectional observational study over a period of 5 years (2016–2021) was undertaken among consecutive stroke and transient ischemic attack (TIA) patients to look for the presence of MMA angiographically. Each patient with angiographically proven MMA was further evaluated for demographic, clinical, and radiological characteristics. Results Among 10,250 consecutive stroke and TIA patients (ischemic = 78%, hemorrhagic = 22%), frequency of MMA was 1.56% (n = 160); 15.3% among children. Female preponderance (Male:Female = 1:1.4) was noted among 160 MMA patients, with bimodal age distribution, first peak at 3–8 years, and a shorter second peak at 41–47 years. Childhood-onset MMA was seen in 75 (46.9%) with commonest initial neurological symptom of fixed-motor-weakness (44.0%), followed by TIA (26.7%); while 85 (53.1%) had adult-onset MMA with fixed-motor-weakness (50.6%) followed by headache (24.7%) as the predominant initial neurological symptom; seizure significantly higher in children (p < 0.001) and headache in adults (p = 0.012). Transient and fixed neurological manifestations constituted 87.5 and 69.4% respectively, of symptoms throughout the disease course. Cerebral infarction (45.0%) and TIA (21.9%) were the commonest types of MMA. On brain imaging, infarction was noted in 80.6%, hemorrhage in 11.3%, significantly higher among adults (p < 0.001). Cortical infarct and Gyral pattern were commoner in children (p = 0.004), subcortical infarcts in adults (p = 0.018). Frequent Suzuki staging observed was stage 4 (31.3%), followed by stage 3 (30.0%). Involvement of posterior circulation was detected in 55.6%, brain atrophy at the time of diagnosis was seen in 65.0%. Conclusion MMA is an important etiological consideration in patients with stroke, especially in children. It can present with a myriad of transient neurological symptoms, frequently overlooked, leading to delayed diagnosis, and contributing to socio-economic burden. Indian MMA showed aberrations in its gender predisposition, age distribution, frequency of familial cases, disease manifestation, and type of stroke, in comparison to its Japanese and Caucasian counterparts pointing to the inter- and intra-continent differences of MMA phenotype. Future development of the Indian MMA national registry is of essence.
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Affiliation(s)
- Shambaditya Das
- Department of Neurology, Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India
| | - Souvik Dubey
- Department of Neurology, Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India
| | - Suman Das
- Department of Neurology, Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Alak Pandit
- Department of Neurology, Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, India
| | - Biman Kanti Ray
- Department of Neurology, Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India
- *Correspondence: Biman Kanti Ray
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Singh R, McLelland MD, De La Peña NM, Pollock JR, Catapano JS, Srinivasan VM, Rahmani R, Lawton MT. Research advances in the diagnosis and treatment of moyamoya disease: a bibliometric analysis. Neurosurg Rev 2022; 45:1977-1985. [PMID: 35150354 DOI: 10.1007/s10143-022-01748-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 11/24/2022]
Abstract
Moyamoya disease is a rare cerebrovascular condition involving stenotic carotid arteries and the formation of abnormal blood vessels. In this study, we aimed to characterize the key players involved in moyamoya research at the individual and institutional level and to identify the critical publications that have advanced our understanding of this disease. We performed a title-specific search of the Web of Science database using the search term "moyamoya" for publications dating from 1900 to April 2020. The 100 most frequently cited articles were obtained, screened for duplicates, and reviewed by 2 independent reviewers. These 100 articles were cited an average of 150 times each (range, 74 to 1,360 citations per article). Publication dates ranged from 1969 to 2016, with the largest number of publications (n=40) cited between 2000 and 2009. The article with the greatest number of citations (1,360 citations) was "Cerebrovascular 'moyamoya' disease: disease showing abnormal net-like vessels in base of brain," by Suzuki and Takaku, published in the Archives of Neurology, 1969. Stroke published the greatest number of the most frequently cited articles (23 of 100). The institution that contributed the most articles was Tohoku University (16%); the majority of the most frequently cited articles originated in Japan (62%). We identified the 100 most cited articles on moyamoya disease over the past 51 years to recognize significant and impactful works. These results can be used as a guide to evaluate our current understanding of moyamoya disease and to direct future efforts.
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Affiliation(s)
- Rohin Singh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, c/o Neuroscience Publications, 350 W. Thomas Rd., AZ, 85013, Phoenix, USA
| | - Marissa D McLelland
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, c/o Neuroscience Publications, 350 W. Thomas Rd., AZ, 85013, Phoenix, USA
| | - Nicole M De La Peña
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, c/o Neuroscience Publications, 350 W. Thomas Rd., AZ, 85013, Phoenix, USA
| | - Jordan R Pollock
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, c/o Neuroscience Publications, 350 W. Thomas Rd., AZ, 85013, Phoenix, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, c/o Neuroscience Publications, 350 W. Thomas Rd., AZ, 85013, Phoenix, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, c/o Neuroscience Publications, 350 W. Thomas Rd., AZ, 85013, Phoenix, USA
| | - Redi Rahmani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, c/o Neuroscience Publications, 350 W. Thomas Rd., AZ, 85013, Phoenix, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, c/o Neuroscience Publications, 350 W. Thomas Rd., AZ, 85013, Phoenix, USA.
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23
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Wu H, Xia C, Li R, Tao C, Tang Q, Hu W. Correlation Between Apelin and Collateral Circulation in Patients with Middle Cerebral Artery Occlusion and Moyamoya Disease. Int J Gen Med 2022; 15:699-709. [PMID: 35082519 PMCID: PMC8784270 DOI: 10.2147/ijgm.s341015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/14/2021] [Indexed: 01/12/2023] Open
Abstract
Background and Objectives Moyamoya disease (MMD) is a unique cerebrovascular occlusive disease with abnormal vascular hyperplasia, which causes cerebrovascular accidents like intracranial arteriosclerosis. This study aimed to explore whether plasma apelin levels are related to good collateral circulation in ischemic diseases, which may be higher in patients with MMD than middle cerebral artery (MCA) occlusion or healthy controls, and may have a connection with the MMD grades. Methods We recruited 68 MMD patients and 25 MCA occlusion patients diagnosed by angiography, including 29 patients without cerebrovascular problems as controls. We examined the plasma apelin, serum nitric oxide (NO), and vascular endothelial growth factor (VEGF) levels of all subjects by ELISA kit. We compared the relationship between apelin, NO, and VEGF in the blood of three groups, to explore the relationship. We also investigated whether the plasma apelin-13, apelin-17, and apelin-36 levels correlate with the MMD classification. Results Univariate analyses indicated that the MMD group had the higher plasma apelin-13, apelin-17, apelin-36, and serum NO levels than the MCA occlusion and healthy control groups. Binary logistic regression analyses further showed that the apelin-13 level was substantially higher in MMD patients than in MCA occlusion patients. Patients with MMD were significantly younger than patients with MCA occlusion by their mean ages. Linear regression analyses were performed to compare apelin levels between different grades of the patients with MMD. Apelin-13, apelin-17, and apelin-36 levels increased with the gradual increase of compensation grades level independent of NO and VEGF. Apelin-13 and apelin-36 showed a positive effect on the compensation scores in MMD. Conclusion Our study demonstrated that apelin-13 was significantly increased in patients with MMD than patients with MCA occlusion independent of NO and VEGF. Moreover, plasma apelin-13, apelin-17, and apelin-36 levels increase with the grades of MMD.
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Affiliation(s)
- Hanlin Wu
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Chengyu Xia
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Rui Li
- Department of Neurology, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Chunrong Tao
- Department of Neurology, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Qiqiang Tang
- Department of Neurology, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Wei Hu
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
- Correspondence: Wei Hu; Qiqiang Tang Email ;
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24
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Ma W, Cui C, Feng S, Li G, Han G, Liu J, Qin X, Hu Y, Wang M, Zhang L, Jin F. Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio in Patients With Newly Diagnosed Moyamoya Disease: A Cross-Sectional Study. Front Neurol 2021; 12:631454. [PMID: 34899551 PMCID: PMC8660107 DOI: 10.3389/fneur.2021.631454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Inflammation has been proven to be one of the key factors in the pathogenesis of moyamoya disease (MMD). Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are cheap and reliable biomarkers of inflammation. Nevertheless, evidence regarding the relationship among PLR and NLR in patients with MMD is limited. The focus of this subject was to explore the relationship between PLR and NLR in patients with newly diagnosed MMD. Patients and methods: A cross-sectional study was performed including 261 patients with diagnosed MMD for the first time who were enrolled from our hospital, from 24 March 2013 to 24 December 2018. The clinical characteristics were collected for each patient. Univariate analysis, smooth curve fitting and multivariate piecewise linear regression were showed. Results: The mean levels or median values (interquartile range) of PLR and NLR were 146.979 ± 51.203 and 2.241 (1.589–2.984), respectively. A significant positive correlation between PLR and NLR levels (P < 0.001) was showed by the univariate analysis. Furthermore, a non-linear relationship was detected between PLR and NLR by smooth curve fitting after adjusting for potential confounders. A multivariate piecewise linear regression model revealed a significant positive correlation between PLR and NLR when the PLR level was lower than 219.82 (β 0.012, 95% CI 0.005, 0.019; P = 0.001). PLR was also significantly positively associated with NLR when PLR concentrations were >219.82 (β 0.098, 95% CI 0.069, 0.128; P < 0.001). Conclusion: There seemed to be a positive association between PLR and NLR in patients with MMD. This may help to further explain the role of inflammation in the occurrence and progress of MMD.
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Affiliation(s)
- Wenyuan Ma
- Clinical Medical College, Jining Medical University, Jining, China
| | - Changmeng Cui
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Song Feng
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Genhua Li
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Guangkui Han
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Jilan Liu
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xianyun Qin
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yawei Hu
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Mengjie Wang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Lu Zhang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Feng Jin
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
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25
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Yu S, Zhang N, Liu J, Li C, Qian S, Xu Y, Yang T, Li N, Zeng M, Li D, Xia C. Surgical revascularization vs. conservative treatment for adult hemorrhagic moyamoya disease: analysis of rebleeding in 322 consecutive patients. Neurosurg Rev 2021; 45:1709-1720. [PMID: 34859335 DOI: 10.1007/s10143-021-01689-w] [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: 08/04/2021] [Revised: 10/06/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022]
Abstract
Whether surgical revascularization can prevent recurrent hemorrhage in hemorrhagic moyamoya disease (HMD) patients remains a matter of debate. This study mainly aims at the comparison of treatment effect between surgical revascularization and conservative treatment of adult HMD patients. We retrospectively enrolled 322 adult HMD patients, including 133 in revascularization group and 189 in conservative group. The revascularization group included patients who underwent combined (n = 97) or indirect revascularization alone (n = 36). Ninety-two and forty-one patients underwent unilateral and bilateral revascularization respectively. The modified Rankin scale (mRS) was used to assess the functional status. The comparison was made based on initial treatment paradigm among two categories: (1) revascularization vs. conservative, (2) unilateral vs. bilateral revascularization. The rebleeding rate was significantly lower in revascularization group than that in conservative group (14.3% vs. 27.0%, P = 0.007). As for the functional outcomes, the average mRS was significantly better in revascularization group (1.7 ± 1.5) than that in conservative group (2.8 ± 1.9) (P < 0.001). The death rate in revascularization group was 8.3% (11/133), comparing to 20.1% (38/189) in conservative group (P = 0.004). While comparing between unilateral and bilateral revascularization within the revascularization group, the result demonstrated lower annual rebleeding rate in bilateral group (0.5%/side-year) than that in unilateral group (3.3%/side-year) (P = 0.001). This study proved the better treatment efficacy of surgical revascularization than that of conservative treatment in HMD patients, regarding both in rebleeding rate and mortality rate. Furthermore, bilateral revascularization seems more effective in preventing rebleeding than unilateral revascularization.
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Affiliation(s)
- Shaojie Yu
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, 230036, Hefei, Anhui, People's Republic of China.,Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Nan Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Jian Liu
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, 230036, Hefei, Anhui, People's Republic of China.,Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Changwen Li
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, 230036, Hefei, Anhui, People's Republic of China.,Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Sheng Qian
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, 230036, Hefei, Anhui, People's Republic of China.,Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Yong Xu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Tao Yang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Nan Li
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Minghui Zeng
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Dongxue Li
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Chengyu Xia
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, 230036, Hefei, Anhui, People's Republic of China. .,Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China.
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26
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M Ali N, Alawad A, Alferayan A, Al-Rumayyan A, Alkoury S. Moyamoya Disease in a 13-Month-Old Middle Eastern Boy. Cureus 2021; 13:e18874. [PMID: 34804723 PMCID: PMC8598685 DOI: 10.7759/cureus.18874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/05/2022] Open
Abstract
Moyamoya disease (MMD) is a rare, chronic cerebrovascular disease affecting the cerebral arteries, leading to the development of unique collateral vessels. Few cases were reported from Saudi Arabia; however, the incidence rate is not well-defined. Hence, we present a case of a 13-month-old child who presented to the emergency room with first onset focal seizures with relatively unremarkable past medical and family history. Investigations were ordered accordingly including head computed tomography (CT) scan, brain magnetic resonance imaging (MRI), and cerebral angiogram, and he was diagnosed with MMD and considering a broader variety of differential diagnoses for seizures in children is highlighted in our case. Furthermore, considering their predominance in east Asian countries, it highlights a rare presentation in the middle eastern race.
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Affiliation(s)
- Nashwa M Ali
- College of Medicine, Alfaisal University, Riyadh, SAU
| | - Abdullah Alawad
- Interventional Radiology, King Saud Medical City, Riyadh, SAU
| | | | - Ahmed Al-Rumayyan
- Neurology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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27
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Prokin AL, Galic V, Boban N. Basilar Artery Dissection in an Adult Patient Presenting with De Novo Moyamoya Disease. Ann Indian Acad Neurol 2021; 24:423-425. [PMID: 34447012 PMCID: PMC8370156 DOI: 10.4103/aian.aian_430_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/27/2020] [Accepted: 06/09/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Aleksandra Lucic Prokin
- Department of Neurology, University Clinical Center of Vojvodina, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vladimir Galic
- Department of Neurology, University Clinical Center of Vojvodina, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nikola Boban
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Center for Radiology, University Clinical Center of Vojvodina, Novi Sad, Serbia
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28
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Hwang JK, Park EK, Kim J, Kang HC, Kim DS, Shim KW. The feasibility of performing multiple burr hole surgery in pediatric moyamoya patients as a response to failed mEDAS. Childs Nerv Syst 2021; 37:2233-2238. [PMID: 33755793 DOI: 10.1007/s00381-021-05093-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the feasibility and clinical effectiveness of performing multiple burr hole surgery in pediatric moyamoya patients as a response to failed modified encephaloduroarteriosynangiosis (mEDAS). METHODS From January 2014 to May 2018, multiple burr hole surgery (MBS) was conducted on 16 hemispheres in 12 patients as a secondary treatment following mEDAS. The male-to-female ratio was 1:2 and the average age at the time of mEDAS was 6 years old. The average patient age was 9 ± 3 years olds (range 7-17) at the time of MBS which occurred an average of 46 months after mEDAS. An average of 10 ± 1 holes (range 8-13) were made. Time-to-peak (TTP) magnetic resonance images (MRI) were taken along 20 axial cuts. Of these cuts, two consecutive cuts on the lateral ventricle were selected to calculate the average value of the region of interest (ROI). The value of the cerebellum was subtracted from the average value of two consecutive cuts. The ROI value was analyzed using a paired t test by SPSS 20 (SPSS Inc., Chicago, IL, USA). RESULTS All 16 cases presented improvement of clinical symptoms as determined by ROI analysis of the TTP MRI images. The average ROI value was 5.03 ± 6.36 before MBS and - 15.54 ± 9.42 after MBS. The average change in the ROI value was - 20.58 ± 12.59. The ROI value decreased in all cases after MBS. Magnetic resonance angiography (MRA) also showed a positive effect on vascularization. CONCLUSION In pediatric moyamoya patients, MBS is recommended as secondary option as a response to failed mEDAS. Its clinical effectiveness was shown by analyzing TTP images and assisted by MRA and digital subtraction angiography.
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Affiliation(s)
- Jun Kyu Hwang
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
| | - Eun Kyung Park
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jinna Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon-Chul Kang
- Department of Pediatric Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Won Shim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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29
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Etli M, Karahan O. Unusual presentation of moyamoya disease with popliteal involvement: case report and review of the literature. J Vasc Bras 2021; 20:e20200216. [PMID: 34211538 PMCID: PMC8218857 DOI: 10.1590/1677-5449.200216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Moyamoya disease is a rare disorder that involves the cerebrovascular system. Usually, it leads to occlusion of the arteries of the cerebral system and causes cerebral circulatory complaints. A 48-year-old female patient was admitted to our clinic with intermittent claudication in both legs. Biphasic and monophasic waveform patterns were detected bilaterally in distal (trifurcation arteries) lower extremities with Doppler sonography. The patient therefore underwent systemic vascular examination. Computed tomography angiography revealed bilateral carotid occlusion at the level of supraclinoid segments, and opacifications were detected at the distal segments of the bilateral anterior cerebellar and middle cerebellar arteries. The patient was diagnosed with moyamoya disease, and anticoagulant treatment was started. In conclusion, most previous reports have presented the cerebrovascular involvement of moyamoya disease. However, this disease can involve different peripheral vascular systems and careful and systemic vascular examination is necessary for an exact diagnosis.
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Affiliation(s)
- Mustafa Etli
- Alaaddin Keykubat University, Medical School, Alanya/Antalya, Turkey
| | - Oguz Karahan
- Alaaddin Keykubat University, Medical School, Alanya/Antalya, Turkey
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30
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Musa J, Rahman M, Guy A, Guy A, Saliaj K, Siddik AB, Hyseni F, Elezi K, Kola I, Cobo A, Ahmetgjekaj I. Silent Moyamoya disease - A rare case report. Radiol Case Rep 2021; 16:1368-1373. [PMID: 33897931 PMCID: PMC8055531 DOI: 10.1016/j.radcr.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 10/26/2022] Open
Abstract
Moyamoya is a rare cerebrovascular disorder marked by chronic, gradual blockage of the circle of Willis arteries, leading to characteristic collateral vessels, specifically cerebral angiography. The disease can develop in children and adults, although there are different clinical characteristics. Moyamoya disease occurs mainly in Japanese people but has been reported in all races of varying age distributions and clinical features. As a reason, Moyamoya disease has been under-recognized as a cause of hemorrhagic and ischemic strokes in Western nations. There is no proven solution at this time, and there is debate over current care methods. The authors identify a case of a 40-year-old male with a small subcutaneous nevus-like mass in his left orbit who was diagnosed with Moyamoya disease.
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Affiliation(s)
- Juna Musa
- Department of Surgery Physiology and Biomedical Engineering, Mayo Clinic, 200 1st St, SW Floor 8 Rochester, MN, 55905, USA
| | - Masum Rahman
- Department of Neurological Surgery, Mayo Clinic, 200 1st St, SW Floor 8, Rochester, MN, 55905, USA
| | - Ali Guy
- Department of Physical Medicine and Rehabilitation, New York University, School of Medicine, NYU Medical Center, 550 1st Avenue, New York, NY, 10016, USA
| | - Angela Guy
- Health Emphasis California School of Professional Psychology Alliant International University, 1000 South Fremont Ave, Unit 5, Alhambra, CA, 91803, USA
| | - Kristi Saliaj
- Mother Teresa hospital university, Rruga e Dibrës 372, Tirana, AL, 1000, Albania
| | - Abu Bakar Siddik
- Department of Pain Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Fjolla Hyseni
- Department of Urology, NYU Langone Health, 11th and 12th Floors, 222 E 41st St, New York, NY, 10017, USA
| | - Ketjana Elezi
- Pharmacist and master in Health management, University of Medicine, Tirana, AL, 1000, Albania
| | - Ina Kola
- Department of Burns and Plastic Surgery, Mother Teresa Hospital, Rruga e Dibrës 372, Tirana, AL, 1000 Albania
| | - Anisa Cobo
- University of Medicine, Tirana, AL, 1000, Albania
| | - Ilir Ahmetgjekaj
- University Clinical Center, Clinic of Radiology, University For Business and Technology –Radiology, Pristina, Kosovo
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31
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Alkhaibary A, Almutairi OT, Elarjani T, Alnefaie N, Alhussinan MA, Bafaquh M, Alturki AY. The Top-100 most cited articles on Moyamoya disease: A bibliometric analysis. J Cerebrovasc Endovasc Neurosurg 2021; 23:85-98. [PMID: 33975427 PMCID: PMC8256026 DOI: 10.7461/jcen.2021.e2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Moyamoya disease (MMD) is a progressive steno-occlusive cerebrovascular phenomenon with unknown pathogenesis. Considering the abundance of articles addressing Moyamoya disease, a detailed analysis concerning the publication trends is of paramount importance. The aim of the study is to report the current knowledge of the top-100 most cited articles on Moyamoya disease in the literature. METHODS A non-time restricted keyword-based search was performed in June 2020 using the Scopus database. The search keywords included the following: "Moyamoya", "Moyamoya disease", and "Moyamoya syndrome". The search result was used to rank the articles based on their citation count. The top-100 most-cited articles were obtained and classified into seven categories. RESULTS A total of 3,543 articles on Moyamoya disease were published between 1955 and 2020. The Top-100 articles were published between 1977 and 2016 with a total of 16,119 citations, per year, and 7.23% rate of self-citation. The 1990s was the most productive decade (N=42). The most contributing country to the list was Japan (N=60). Stroke was the most active journal (N=23). Houkin, K., a Japanese neurosurgeon, was the most prolific author (N=15). CONCLUSIONS Moyamoya disease has been extensively investigated in the literature throughout the years. The majority of articles published in the literature were addressing the surgical management and clinical outcome. Authors from neurosurgical backgrounds were the most active contributors to the field of Moyamoya disease.
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Affiliation(s)
- Ali Alkhaibary
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Othman T Almutairi
- Department of Adult Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Turki Elarjani
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Nada Alnefaie
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Mohammed Bafaquh
- Neurocritical Care Division, Critical Care Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Y Alturki
- Department of Adult Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.,Neurocritical Care Division, Critical Care Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Aihara Y, Kashiwase S, Chiba K, Yamaguchi K, Okada Y, Kimura T, Kawamata T. Aspirin use and platelet aggregation in ischemic onset-type pediatric moyamoya patients with intractable headaches (moya-ache). Childs Nerv Syst 2021; 37:1649-1657. [PMID: 33404716 DOI: 10.1007/s00381-020-04991-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND NSAIDs (nonsteroidal anti-inflammatory drugs) were administered to patients with ischemic onset-type moyamoya disease who experience headaches, but their therapeutic effect was very poor and resulted in a drop in quality of life (QOL). On the other hand, patients who were administered aspirin initially to prevent transient ischemic attacks (TIA) were observed to have a better QOL with the absence of headaches. Here, we report on patients with ischemic onset-type moyamoya disease experiencing headaches who received aspirin in order to verify its safety and effectiveness. METHODS From October 2012 to July 2014, 35 patients (male: 19, female: 16 average age: 10.5 ± 3.9) with ischemic onset-type pediatric moyamoya disease and who were admitted or commuted to hospital and had surgical treatment were evaluated for background, moyamoya staging (Suzuki), presence/absence of TIA, and platelet aggregation activity by adenosine diphosphate (ADP)/collagen turbidity test. The patients were divided into four groups depending on the intensity of headache prior to being administered aspirin, and the Kruskal-Wallis test was carried out for platelet aggregation activity and moyamoya staging. Also, the 4 × 2 χ2 test was carried out for the presence/absence of TIA. Next, the items which were significant in these tests were used as independent variables to analyze the risk of headache onset, using logistic regression analysis. RESULTS One item with statistical significance was the platelet aggregation test(PAT) value (on collagen) (P < 0.0001). A logistic regression analysis was carried out, using this value as an independent variable and headache intensity-as a dependent variable. As a result, an increase in PAT value by 1 translated into 4.43 times higher risk of the onset of intractable headache, and the onset of intractable headaches was predicted at 58.8% with collagen. The risk of developing a headache decreased as a result of aspirin administration, and the decrease was dependent on the collagen-induced aggregation suppression effect of aspirin. Aspirin was administered in the range of 1.6~9.5 mg/kg/day, and the PAT value decreasing rate was 42.9% on average. One case alone experienced nasal bleeding, and all cases showed an improvement in the intractable headaches. CONCLUSIONS In patients with ischemic onset-type pediatric moyamoya disease who experience headaches, the platelet aggregation activity is accelerated, and aspirin administration is effective in alleviating headaches by inhibiting platelet activation, detected by the collagen PAT.
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Affiliation(s)
- Yasuo Aihara
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Shinobu Kashiwase
- Department of Pharmacy, Tokyo Women's Medical University, Tokyo, Japan
| | - Kentaro Chiba
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
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Chen D, Zhang G, Wang J, Chen S, Wang J, Nie H, Tang Z. Mapping Trends in Moyamoya Angiopathy Research: A 10-Year Bibliometric and Visualization-Based Analyses of the Web of Science Core Collection (WoSCC). Front Neurol 2021; 12:637310. [PMID: 33737903 PMCID: PMC7960774 DOI: 10.3389/fneur.2021.637310] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Moyamoya angiopathy (MMA), which includes moyamoya disease (MMD) and moyamoya syndrome (MMS), is an uncommon cerebrovascular condition characterized by recurrent stroke. We carried out a bibliometric analysis to examine the development of and research trends in MMA research. Methods: Studies published between 2010 and 2019 on MMA were retrieved from the Web of Science Core Collection (WoSCC) on August 14, 2020, and bibliometric and visualization-based analyses were performed by using three different scientometric tools: HistCite, VOSviewer, and CiteSpace. Results: A total of 1,896 publications published in 384 journals by 6,744 authors, 1,641 institutions and 56 countries/regions were included in the analyses. Annual publication outputs increased from 2010 to 2019. The USA, Japan and China were three key contributors to this study field. Capital Medical University, Seoul National University, and Stanford University were three major institutions with larger numbers of publications. Zhang D, World Neurosurgery, Kuroda S, and STROKE were the most prolific author, prolific journal, top co-cited author and top co-cited journal, respectively. The top five keywords during this period were moyamoya disease, revascularization, stroke, children and surgery, while revascularization surgery and RNF213 were the most common frontier topics. Conclusions: In this study, the research trends of global scientific research on MMA over the past decade were systematically analyzed. The study can provide guidance for scholars who want to understand current trends in research in this area and new research frontiers.
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Affiliation(s)
- Danyang Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, China
| | - Ge Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, China
| | - Jiahui Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, China
| | - Jingxuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, China
| | - Hao Nie
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, China
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Alhashem AT, AlSalem KH, Sabihah SJ, Alfaraj D. Moyamoya Syndrome Presenting as Refractory Status Epilepticus in a 32-Year-Old Female. Cureus 2021; 13:e13624. [PMID: 33816023 PMCID: PMC8010915 DOI: 10.7759/cureus.13624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Moyamoya disease (MMD) is a rare cerebrovascular occlusion condition characterized by progressive stenosis in the terminal portion of the internal carotid arteries on both sides. The measured incidence of MMD is 0.086 per 100,000 people. MMD has variable neurological manifestations, however, seizure is a significant manifestation of MMD with few reported studies. The combination of sickle cell disease (SCD) and MMD confers a much higher risk of ischemic stroke. In this paper, we describe a 32-year-old female with a known case of SCD taking tramadol for a vaso-occlusive crisis, who was presented to the emergency department by a family member due to a low level of consciousness. Despite ongoing management, the patient developed multiple seizure attacks and intubation was performed. A computed tomography (CT) brain angiogram was performed, and the diagnosis of MMD was made. The patient was shifted to the intensive care unit (ICU) and in spite of the ongoing management in the ICU, the patient died. In this case, we highlight the importance of considering MMD as a differential diagnosis when dealing with an SCD patient who developed refractory status epilepticus.
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Affiliation(s)
- Ali T Alhashem
- Emergency Medicine, King Faisal University, Al Hofuf, SAU
| | | | | | - Dunya Alfaraj
- Emergency Medicine, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Liu J, Xu Q, Niu H, Wang R, Ye X, Liu X. Postoperative incidence of seizure and cerebral infarction in pediatric patients with epileptic type moyamoya disease: a meta-analysis of single rate. Chin Neurosurg J 2021; 7:11. [PMID: 33526093 PMCID: PMC7852094 DOI: 10.1186/s41016-020-00224-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Surgery is a conventional mature treatment for moyamoya disease (MMD). However, whether surgery is also an effective therapy for epileptic type MMD has seldom been investigated systematically. The study aims to summarize the pooled postoperative incidence of seizure and cerebral infarction in pediatric patients with epileptic type moyamoya disease. Method The study was a systematic review and critical appraisal with a meta-analysis of cohort studies, both prospective and retrospective. Studies were identified by a computerized search of PubMed, Embase, Web of Science, Wanfang, and CNKI databases. In a literature search, a total of 7 cohort studies were identified. The I2statistic was used to quantify heterogeneity. A fixed-effect model was used to synthesize the results. The linear regression test of funnel plot asymmetry was used to estimate the potential publication bias. Results The pooled estimated postoperative incidence of seizure in pediatric patients with epileptic type moyamoya disease was 23.44%. The pooled estimated postoperative incidence of cerebral infarction in pediatric patients with epileptic type moyamoya disease was 9.12%. Low substantial heterogeneity and potential publication bias were present. Conclusions Evidence from this study suggests that the postoperative incidence of seizure and cerebral infarction is relatively low. Surgery is an effective and secure therapy for pediatric patients with epileptic type moyamoya disease.
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Affiliation(s)
- Jingjing Liu
- Peking University International Hospital, Department of Neurology, Peking University, Beijing, China.,Boston Children's Hospital, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Harvard Medical School, Boston, USA
| | - Qinlan Xu
- Peking University International Hospital, Department of Neurology, Peking University, Beijing, China
| | - Hongchuan Niu
- Peking University International Hospital, Department of Neurosurgery, Peking University, Beijing, China
| | - Rong Wang
- Peking University International Hospital, Department of Neurosurgery, Peking University, Beijing, China.,Beijing Tiantan Hospital, Department of Neurosurgery, Capital Medical University, Beijing, China
| | - Xun Ye
- Peking University International Hospital, Department of Neurosurgery, Peking University, Beijing, China. .,Beijing Tiantan Hospital, Department of Neurosurgery, Capital Medical University, Beijing, China.
| | - Xianzeng Liu
- Peking University International Hospital, Department of Neurology, Peking University, Beijing, China.
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Barreto-Duarte B, Andrade-Gomes FH, Arriaga MB, Araújo-Pereira M, Cubillos-Angulo JM, Andrade BB. Association between neurofibromatosis type 1 and cerebrovascular diseases in children: A systematic review. PLoS One 2021; 16:e0241096. [PMID: 33395412 PMCID: PMC7781472 DOI: 10.1371/journal.pone.0241096] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/19/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF-1) is an autosomal dominant disease that affects one in every 3000 individuals. This disease can present a wide range of clinical manifestations, ranging from skin abnormalities to severe vascular damage. Although not commonly recognized in the context of NF-1, cerebrovascular disease (CVD), can be often present since childhood and diagnosed just later in life. When present, NF-1-associated CVD clinical manifestations may include headache, cognitive deficits and ultimately aneurysm rupture, causing death. Thus, CVD plays an important role in the clinical manifestations, disease severity and prognosis of patients with NF-1. This systematic review aims to summarize the body of evidence linking NF-1 and CVD in children. METHODS Two independent investigators performed a systematic review on the PubMed and EMBASE search platforms, using the following key terms: "neurofibromatosis type 1", "Von Recklinghausen's disease", "children", "adolescents", "stroke", "Moyamoya disease", "vascular diseases", "cerebrovascular disorders", "aneurysm" and "congenital abnormalities". Studies focused on assessing the development of CVD in children with NF-1 were included. RESULTS Seven studies met the inclusion criteria. Twelve different clinical manifestations have been associated with cerebrovascular changes in children with NF-1; 44,5% of diagnosed patients were asymptomatic. CONCLUSION The available evidence suggests that CVDs are related with the progression of NF-1, even in the absence of a clear clinical manifestation. In addition, improved prognosis was observed when imaging tests were performed to screen for cerebrovascular alterations early during the clinical investigation. Early diagnosis of CVD in NF-1 patients foster implementation of timely interventions, directly impacting clinical outcomes.
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Affiliation(s)
- Beatriz Barreto-Duarte
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: (BBA); (BBD)
| | | | - María B. Arriaga
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
- Curso de Medicina, Centro Universitário Faculdade de Tecnologia e Ciências (UniFTC), Salvador, Bahia, Brazil
| | - Mariana Araújo-Pereira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Juan Manuel Cubillos-Angulo
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
- Curso de Medicina, Centro Universitário Faculdade de Tecnologia e Ciências (UniFTC), Salvador, Bahia, Brazil
| | - Bruno B. Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Curso de Medicina, Centro Universitário Faculdade de Tecnologia e Ciências (UniFTC), Salvador, Bahia, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
- * E-mail: (BBA); (BBD)
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Viso R, Lylyk I, Albiña P, Lundquist J, Scrivano E, Lylyk P. Hemorrhagic events associated with unfused or twig-like configuration of the Middle cerebral artery: A rare vascular anomaly with clinical relevance. Interv Neuroradiol 2020; 27:285-290. [PMID: 33121291 DOI: 10.1177/1591019920970430] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Twig-like middle cerebral artery configuration (Tw-MCA) is a rare and commonly misdiagnosed vascular anomaly characterized by a plexiform arterial network that replaces the normal M1 segment. The prevalence and clinical relevance of this anomaly is not fully established. MATERIAL AND METHODS We sought to explore the prevalence of Tw-MCA in patients clinically referred to digital angiography in a single academic comprehensive endovascular center and evaluated the radiological and clinical findings among patients with hemorrhagic events. RESULTS From 2011 to 2020, a total of 10,234 patients underwent a cerebral angiography at our institution. During this period, 9 (0.088%) Tw-MCAs were identified. Out of these, 5 patients (62.5%) were admitted due to an intracranial hemorrhage. Two patients had a ruptured intracranial aneurysm on the anterior communicating artery, one with multiple brain aneurysms; two patients presented an intraparenchymal hematoma (IPH) due to the presence of a periventricular anastomosis and one patient an intraventricular hemorrhage with unclear origin. CONCLUSION Tw-MCA is a very rare vascular anomaly associated with hemorrhagic events. Adequate identification of this anomaly is essential in order to avoid misdiagnosis as steno-occlusive disorders.
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Affiliation(s)
- Rene Viso
- Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Ivan Lylyk
- Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Pablo Albiña
- Departamento de Neurocirugía, Hospital Barros Luco Trudeau, Santiago, Chile.,Departamento de Anatomía, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Lundquist
- Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Esteban Scrivano
- Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Pedro Lylyk
- Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
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Abstract
Moyamoya disease (MMD) is an infrequent disease of cerebral vasculature characterized by long-standing and progressive occlusion of large intracranial arteries. It is seen predominantly in the East Asian population. Most of the cases of MMD are sporadic, but there is a small percentage that is familial. The mode of inheritance is reported to be autosomal dominant with incomplete penetrance. Studies show that the susceptibility gene of MMD is located on chromosome 17. The clinical presentation is variable and is influenced by the age and geographic region of the patient. Children mainly present with ischemia-related neurologic episodes whereas MMD in adults can manifest as either an ischemic event or an intracranial hemorrhage (ICH). The gold standard investigation for diagnosis is cerebral angiography which reveals a smoky appearance of arteries at the base of the skull, thus granting the disease its name. The treatment is mostly surgical and includes direct and indirect revascularization procedures, which prevent the recurrence of both ischemic and hemorrhagic strokes. However, combination revascularization procedures are now on the rise due to studies showing better long-term outcomes. The aim of the article is to critically analyze the current literature and updates on various aspects of MMD including, but not limited to, etiology, diagnosis, and treatment.
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Affiliation(s)
- Apurv Gupta
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Anshika Tyagi
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Moises Romo
- Department of Medicine and Nutrition, University of Guanajuato, Leon, MEX
| | - Krystal C Amoroso
- Department of Medicine, University of West Indies, St. Augustine, TTO
| | - Fnu Sonia
- Department of Medicine, Albert Einstein College of Medicine, Bronx, USA
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Yamani M, Obaid EF, Hemida AH. Moyamoya Syndrome in a 32-Year-Old Male With Sickle Cell Anemia. Cureus 2020; 12:e10001. [PMID: 32983699 PMCID: PMC7515146 DOI: 10.7759/cureus.10001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 11/25/2022] Open
Abstract
Moyamoya disease (MMD) is an unusual vasculopathy in which the blood vessels of the brain are occluded, resulting in thrombosis. When MMD occurs in association with an underlying pathology, it is known as moyamoya syndrome. The association of moyamoya syndrome with sickle cell disease is uncommon. Herein, we report a case of moyamoya syndrome in a 32-year-old male adult patient.
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Affiliation(s)
| | - Elaf F Obaid
- Internal Medicine, Al Noor Specialist Hospital, Mecca, SAU
| | - Amr H Hemida
- Internal Medicine, Al Noor Specialist Hospital, Mecca, SAU
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Zhu B, Liu X, Zhen X, Li X, Wu M, Zhang Y, Zhao Z, Zhang D, Zhao J. RNF213 gene polymorphism rs9916351 and rs8074015 significantly associated with moyamoya disease in Chinese population. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:851. [PMID: 32793695 DOI: 10.21037/atm-20-1040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Gene polymorphism especially Ring Finger Protein 213 (RNF213) p.R4810K is one of the main cause of moyamoya disease (MMD) in Asian populations, especially among Japanese people. However, missense mutation may not explain the reduced frequency of MMD in Chinese patients. We performed a hospital based case-control study in a Chinese population to elucidate the possible underlying reasons. Methods Five gene polymorphism loci, namely, rs35692831, rs9916351, rs9913636, rs8074015 and rs112735431, were included. A total of 98 patients and 114 healthy controls were enrolled in the study. Genomic DNA was genotyped by Mass Array methods. Results A significant difference was observed between patients and healthy controls in rs9916351, rs9913636, and rs8074015 loci under three genotypes and allelic models (P<0.01). Logistic regression analysis revealed the significant differences under the dominant, recessive and additional model in rs9916351 [odds ratio (OR) =4.173, 95% confidence interval (CI): 2.290-7.606, P<0.001; OR =3.152, 95% CI: 1.585-6.267, P=0.001; OR =0.199, 95% CI: 1.727-3.764, P<0.001; respectively] and rs8074015 (OR =0.359, 95% CI: 0.206-0.627, P<0.001; OR =0.348, 95% CI: 0.148-0.81, P=0.015; OR =0.208, 95% CI: 0.311-0.703, P<0.001; respectively), even adjusting for age and gender. In addition, the haplotype rs9913636-rs8074015 under "GACG" showed significant association with MMD. Conclusions Our results had revealed the polymorphism of RNF213 rs9916351 and rs8074015 were significantly associated with MMD especially in Chinese population.
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Affiliation(s)
- Bin Zhu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingju Liu
- Department of Neurosurgery, 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 Disorder, Beijing, China
| | - Xueke Zhen
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Xixi Li
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingfen Wu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, 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 Disorder, Beijing, China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, 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 Disorder, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, 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 Disorder, Beijing, China
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Tanaka R, Shimojima Y, Ueno KI, Takasone K, Ichikawa T, Kishida D, Sekijima Y. Moyamoya syndrome related to systemic lupus erythematosus developing during pregnancy: a case-based review. Clin Rheumatol 2020; 39:3861-3867. [PMID: 32562069 DOI: 10.1007/s10067-020-05246-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 02/04/2023]
Abstract
Moyamoya syndrome (MMS) is a chronic cerebrovascular disorder characterized by occlusion or stenosis of the internal carotid arteries with the formation of abnormal collateral vascular networks. Moreover, the development of MMS, which is a distinct category from "moyamoya disease," is attributed to the underlying disease, while some cases of MMS related to systemic lupus erythematosus (SLE) have been previously reported. Herein, we present the case of a 29-year-old Japanese woman with SLE in whom intracranial hemorrhage ascribable to MMS developed during pregnancy. Craniotomy was performed to remove hematoma, and prednisolone, tacrolimus, and hydroxychloroquine were consecutively administered. She ultimately achieved remission and childbearing without the relapse of cerebrovascular event. To our knowledge, this is the first report of MMS associated with SLE in pregnancy. Through reviewing published English articles and our case, it was suggested that the pathogenesis of SLE is implicated in the development of moyamoya vasculopathy leading to cerebrovascular events. Moreover, pregnancy may affect the bleeding from the fragile collateral vessel wall.
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Affiliation(s)
- Rika Tanaka
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Ken-Ichi Ueno
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Ken Takasone
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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43
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Wang YY, Zhou KY, Ye Y, Song F, Yu J, Chen JC, Yao K. Moyamoya Disease Associated With Morning Glory Disc Anomaly and Other Ophthalmic Findings: A Mini-Review. Front Neurol 2020; 11:338. [PMID: 32499749 PMCID: PMC7242724 DOI: 10.3389/fneur.2020.00338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/07/2020] [Indexed: 12/01/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic cerebrovascular disease that frequently results in intracranial ischemia or hemorrhage. Its concurrence with varying ophthalmic findings is relatively rare yet may lead to irreversible blindness. We performed a search and review of the literature to characterize the relevance of MMD (excluding moyamoya syndrome) and ophthalmic findings. As a result, a total of 38 articles identified from PubMed and Web of Science were included in this mini-review. Patients with MMD sometimes present with decreased visual acuity or visual field defects before the onset of symptomatic cerebrovascular dysfunction. The most predominant ophthalmic condition in MMD patients is the morning glory disc anomaly (MGDA). Deficiency during neuroectodermal genesis and subsequent mesodermal changes may be responsible for the association between these two diseases. Thus, it may be beneficial for patients with MGDA to receive cerebral vascular examinations as the precaution against life-threatening intracranial angiopathy. Other ophthalmic findings reported in cases of MMD include retinal vascular occlusion, optic disc pallor, cortical blindness, etc. For most of the patients with MMD, retinal examinations would be recommended to prevent potential loss of vision. It is essential for both neurologists and ophthalmologists to be aware of the correlation between cerebrovascular diseases such as MMD and ocular manifestations to achieve a comprehensive diagnosis.
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Affiliation(s)
- Yue-Ye Wang
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ke-Yao Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yang Ye
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Song
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jin-Cao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Ya J, Zhou D, Ding J, Ding Y, Ji X, Yang Q, Meng R. High-resolution combined arterial spin labeling MR for identifying cerebral arterial stenosis induced by moyamoya disease or atherosclerosis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:87. [PMID: 32175380 DOI: 10.21037/atm.2019.12.140] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Distinguishing moyamoya disease (MMD) from intracranial atherosclerotic stenosis (IAS) is critical for its treatment and outcome evaluation. This study aimed to use the combined sequences of high-resolution magnetic resonance imaging (HRMRI) and arterial spin labeling MR (ASL-MR) to identify the two entities accurately. Methods This prospective study enrolled 58 patients with middle cerebral artery (MCA) steno-occlusion identified by digital subtraction angiography (DSA), including 27 cases of MMD and 31 cases of IAS. All patients underwent MRA, HRMRI and ASL-MR prior to DSA. Two radiologists blinded to DSA results analyzed the MR images. The inner and outer diameters of the target arteries, the wall thickness of the stenotic segment, and the perfusion status in the territories of the target arteries [cerebral blood flow (CBF), cerebral blood volume (CBV) and arterial transit time (ATT)] were measured quantitatively. The differences between MMD and IAS regarding the aspects of HRMRI and Pseudo-continuous ASLMR (PCASL-MR) maps were analyzed based on both visual characteristics and data information. Results Regarding the HRMRI images, MMD tended to have homogeneous and concentric vessel-wall thickening as well as collaterals adjacent to the stenotic vessels; while IAS showed eccentric and heterogeneous vessel-wall thickening. For the CBF maps of PCASL-MR, abnormal hyper-perfused spots embedded inside the hypo-perfused regions were observed in MMD instead of IAS. Quantitative analysis revealed that MMD displayed smaller inner and outer diameters, and smaller maximum wall thickness, higher average value of CBF, CBV and ATT, and higher maximum value of CBF and CBV, when compared to IAS (all P<0.01). The average wall thickness and the maximum value of ATT showed no significant difference between MMD and IAS (P>0.01). Conclusions HRMRI combined with PCASL-MR may help distinguish MMD and IAS induced cerebral arterial stenosis and cerebral perfusion disorder accurately and non-invasively.
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Affiliation(s)
- Jingyuan Ya
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jiayue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xunming Ji
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Qi Yang
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Department of Neuroimaging, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Yang J, Song GF, Li HB, Zhang SH, Yang FY. Clinical efficacy of extracranial-intracranial bypass for the treatment of adult patients with moyamoya disease: A protocol of systematic review of randomized controlled trials. Medicine (Baltimore) 2019; 98:e18211. [PMID: 31804345 PMCID: PMC6919537 DOI: 10.1097/md.0000000000018211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Moyamoya disease (MMD) is a major health concern associated with blocked arteries at the base of the brain. The aim of this study will synthesize the current evidence of the efficacy and safety of extracranial-intracranial bypass (EIB) for the treatment of adult patients with MMD. METHODS A systematically and comprehensively literature search will be performed in PubMed, EMBASE, Web of Science, CENTRAL, CINAHL, AMED, CBM, and CNKI to identify relevant randomized controlled trails (RCTs) investigating the efficacy and safety of EIB for treating MMD. We will search all above electronic databases from their inception to the July 30, 2019. Two review authors will independently perform study selection, data extraction, and conduct risk of bias evaluation using Cochrane risk of bias tool. We will also explore heterogeneity across studies. RevMan 5.3 software will be applied for statistical analysis performance. RESULTS This study will evaluate the efficacy and safety of EIB for the treatment of adult patients with MMD. CONCLUSION The results of this study will provide latest evidence of the efficacy and safety of EIB for MMD. DISSEMINATION AND ETHICS This study is based on published studies, thus, no ethical consideration is needed. The results of this study are expected to be published in peer-reviewed journals or will be presented on conference meeting.Systematic review registration: PROSPERO CRD42019155839.
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Affiliation(s)
| | | | | | | | - Fu-yi Yang
- Department of Neurology, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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Serum Uric Acid and Triglycerides in Chinese Patients with Newly Diagnosed Moyamoya Disease: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9792412. [PMID: 31355289 PMCID: PMC6634014 DOI: 10.1155/2019/9792412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/08/2019] [Accepted: 06/13/2019] [Indexed: 12/13/2022]
Abstract
Background Evidence regarding the relationship between serum uric acid and triglycerides is limited. Therefore, the specific objective of this study was to investigate whether serum uric acid was independently related to triglycerides in Chinese patients with newly diagnosed moyamoya disease after adjusting for other covariates. Methods The present study was a cross-sectional study. A total of 261 Chinese patients with newly diagnosed moyamoya disease were recruited from a hospital in China from 24 March 2013 to 24 December 2018. The independent variable and the dependent variable were serum uric acid measured at baseline and triglycerides, respectively. The covariates involved in this study included age, sex, body mass index, smoking status, and alcohol consumption. Results The average age of the 227 selected participants was 47.5 ± 12.6 years old, and approximately 48.5% of them were male. The results of the fully adjusted linear regression showed that serum uric acid (10 μmol/L) was positively associated with triglycerides (mmol/L) after adjusting for confounders (β 0.048, 95% CI 0.032, 0.064). Conclusions In patients with moyamoya disease, there seemed to be a positive association between serum uric acid and triglycerides.
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