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Birkeland P, Hansen V, Tharmabalan V, Lauritsen J, Nielsen T, Truelsen T, Rosenbaum S, von Weitzel-Mudersbach P. Long-term stroke risk in Moyamoya disease. Int J Stroke 2024; 19:452-459. [PMID: 37950387 DOI: 10.1177/17474930231216037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Moyamoya disease (MMD) is considered a progressive disease with an ongoing risk of recurrent stroke. However, there is a lack of long-term observational data to quantify the extent of the stroke risk. METHODS This study aimed to provide insight into the long-term stroke risk in MMD and explore possible risk factors for stroke. Records from all patients diagnosed with MMD in 13 clinical departments from 6 different Danish hospitals between 1994 and 2017 were retrospectively reviewed until 2021. RESULTS The cohort comprised 50 patients (33 females and 17 males). Patients were followed up for a median of 9.4 years, with more than 10 years of follow-up for 24 patients. Ten patients had 11 new stroke events-6 ischemic strokes and 5 brain hemorrhages. Events occurred at a median of 7 years and up to 25 years after diagnosis. The overall Kaplan-Meier 5-year stroke risk was 10%. Patients with bypass performed had significantly fewer events than conservatively treated patients (HR 0.25, 95% confidence interval (CI) 0.07-0.91, p < 0.05). All but one event occurred in females, a difference that reached statistical significance. CONCLUSIONS The study provides data on the extent of the risk of recurrent stroke in MMD. Bypass surgery patients had fewer stroke events than those treated conservatively. There was a trend toward a higher stroke risk in females. DATA ACCESS STATEMENT The data supporting this study's findings are available from the corresponding author upon reasonable request.
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Affiliation(s)
- Peter Birkeland
- Department of Neurosurgery, Copenhagen University Hospital, København Ø, Denmark
| | - Victoria Hansen
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Vinosha Tharmabalan
- Department of Neurosurgery, Copenhagen University Hospital, København Ø, Denmark
| | - Jens Lauritsen
- Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Troels Nielsen
- Department of Neurosurgery, Odense University Hospital, Odense C, Denmark
| | - Thomas Truelsen
- Department of Neurology, Copenhagen University Hospital, København Ø, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Bispebjerg Hospital, København, Denmark
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Wang X, Meng Y, Song D, Tan C, Wang G, Lv B, Ni Y, Xie G, Cui T, Zhang Y, Niu Y, Zhang C, Liu G. Comparison of Changes in Retinal Vascular Parameters and Density in Patients with Moyamoya Disease: A Retrospective Study. Ophthalmic Res 2024; 67:211-220. [PMID: 38484716 DOI: 10.1159/000538296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/26/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION This study aimed to compare retinal vascular parameters and density in patients with moyamoya disease using the optical coherence tomography angiography. METHODS This clinical trial totally enrolls 78 eyes from 39 participants, and all these patients with moyamoya disease (N = 13) are set as experimental group and participants with health who matched with age and gender are considered as the control group (N = 26). Then all these participants receive optical coherence tomography angiography detection. Participants' general data are collected and analyzed. Skeleton density (SD) value, vessel density (VD) value, fractal dimension (FD) value, vessel diameter index (VDI) value, foveal avascular zone (FAZ) value are analyzed. RESULTS A total of 39 participants are included in this study. The SD value in the experimental group was significantly lower than that in control group (0.175 [0.166, 0.181] vs. 0.184 [0.175, 0.188], p = 0.017). Similarly, the VD value in the experimental group was significantly lower than that in the control group (0.333 [0.320, 0.350] vs. 0.354 [0.337, 0.364], p = 0.024). Additionally, the FD value in the experimental group was significantly lower than that in the control group (2.088 [2.083, 2.094] vs. 2.096 [2.090, 2.101], p = 0.022). As for the VDI and FAZ, VDI and FAZ values in the experimental group were lower than those in the control group, there was no significant difference in VDI and FAZ values between the two groups. CONCLUSIONS Our study, using non-invasive and rapid OCTA imaging, confirmed decreased retinal vascular parameters and density in patients with moyamoya disease.
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Affiliation(s)
- Xijuan Wang
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Ying Meng
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Dan Song
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Cunxin Tan
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Guanzheng Wang
- PingAn Technology (Shenzhen) Co., Ltd., Shenzhen, China
- PingAn Technology, PingAn IFC, Beijing, China
| | - Bin Lv
- PingAn Technology (Shenzhen) Co., Ltd., Shenzhen, China
- PingAn Technology, PingAn IFC, Beijing, China
| | - Yuan Ni
- PingAn Technology (Shenzhen) Co., Ltd., Shenzhen, China
- PingAn Technology, PingAn IFC, Beijing, China
| | - Guotong Xie
- PingAn Technology (Shenzhen) Co., Ltd., Shenzhen, China
- PingAn Technology, PingAn IFC, Beijing, China
| | - Ting Cui
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Yan Zhang
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Yaqian Niu
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Chengxia Zhang
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Guangfeng Liu
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
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Xu Y, Chen B, Guo Z, Chen C, Wang C, Zhou H, Zhang C, Feng Y. Identification of diagnostic markers for moyamoya disease by combining bulk RNA-sequencing analysis and machine learning. Sci Rep 2024; 14:5931. [PMID: 38467737 PMCID: PMC10928210 DOI: 10.1038/s41598-024-56367-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/05/2024] [Indexed: 03/13/2024] Open
Abstract
Moyamoya disease (MMD) remains a chronic progressive cerebrovascular disease with unknown etiology. A growing number of reports describe the development of MMD relevant to infection or autoimmune diseases. Identifying biomarkers of MMD is to understand the pathogenesis and development of novel targeted therapy and may be the key to improving the patient's outcome. Here, we analyzed gene expression from two GEO databases. To identify the MMD biomarkers, the weighted gene co-expression network analysis (WGCNA) and the differential expression analyses were conducted to identify 266 key genes. The KEGG and GO analyses were then performed to construct the protein interaction (PPI) network. The three machine-learning algorithms of support vector machine-recursive feature elimination (SVM-RFE), random forest and least absolute shrinkage and selection operator (LASSO) were used to analyze the key genes and take intersection to construct MMD diagnosis based on the four core genes found (ACAN, FREM1, TOP2A and UCHL1), with highly accurate AUCs of 0.805, 0.903, 0.815, 0.826. Gene enrichment analysis illustrated that the MMD samples revealed quite a few differences in pathways like one carbon pool by folate, aminoacyl-tRNA biosynthesis, fat digestion and absorption and fructose and mannose metabolism. In addition, the immune infiltration profile demonstrated that ACAN expression was associated with mast cells resting, FREM1 expression was associated with T cells CD4 naive, TOP2A expression was associated with B cells memory, UCHL1 expression was associated with mast cells activated. Ultimately, the four key genes were verified by qPCR. Taken together, our study analyzed the diagnostic biomarkers and immune infiltration characteristics of MMD, which may shed light on the potential intervention targets of moyamoya disease patients.
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Affiliation(s)
- Yifan Xu
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, 16 Jiang Su Road, Qingdao City, 266000, China
| | - Bing Chen
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, 16 Jiang Su Road, Qingdao City, 266000, China
| | - Zhongxiang Guo
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, 16 Jiang Su Road, Qingdao City, 266000, China
| | - Cheng Chen
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, 16 Jiang Su Road, Qingdao City, 266000, China
| | - Chao Wang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, 16 Jiang Su Road, Qingdao City, 266000, China
| | - Han Zhou
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, 16 Jiang Su Road, Qingdao City, 266000, China
| | - Chonghui Zhang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, 16 Jiang Su Road, Qingdao City, 266000, China
| | - Yugong Feng
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, 16 Jiang Su Road, Qingdao City, 266000, China.
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Chen J, Zheng H, Wu X, Niu X, Dai Y, Zhou Z, Ye F. Neuregulin 1 as a potential biomarker for disease progression in moyamoya disease: A case-control study in Chinese population. J Stroke Cerebrovasc Dis 2024; 33:107581. [PMID: 38224792 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/07/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE Moyamoya disease (MMD) is a rare and progressive stenosis of cerebral arteries characterized by abnormally proliferative vasculopathy. Current studies have demonstrated that Neuregulin 1 (NRG1) plays a key role in angiogenesis-related disorders. Thus, the aim of our study is to investigate the serum NRG1 levels and their clinical correlations in MMD patients. METHODS In this study, thirty adult patients with MMD and age-gender matched healthy controls were enrolled from our hospital between July 2020 and April 2022. Peripheral blood samples were collected at baseline, and clinical data were obtained from the electronic medical record system. Serum NRG1 concentrations were measured by enzyme-linked immunosorbent assay. Sanger sequencing was applied to detect the RNF213 p.R4810K mutation. RESULTS The serum NRG1 levels were significantly higher in MMD patients compared to controls (14.48 ± 10.81 vs.7.54 ± 6.35mmol/L, p < 0.001). No statistical difference in baseline clinical characteristics was found between both groups. Correlation analyses showed that NRG1 levels were positively associated with Suzuki staging (r = 0.4137, p = 0.023) while not related to other clinical features (reduced cerebral blood flow, posterior cerebral artery involvement, bilateral or unilateral steno-occlusive changes). Furthermore, subgroup analysis revealed that MMD patients with the RNF213 p.R4810K mutation presented with significantly higher NRG1 levels than those without the mutation (9.60 ± 0.929 vs. 25.89 ± 4.338 mmol/L, p = 0.001). CONCLUSIONS Our study suggests that increased serum NRG1 levels may constitute a characteristic feature of MMD, indicating a potential positive correlation with disease progression and the presence of the RNF213 mutation. This positions NRG1 as a potentially crucial target for further studies aimed at comprehending the pathogenesis of MMD.
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Affiliation(s)
- Jie Chen
- Department of Neurology and Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hanyue Zheng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxin Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingyang Niu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuanyuan Dai
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenhua Zhou
- Department of Neurology and Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
| | - Fei Ye
- Department of Neurology and Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
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Das S, Chakraborty AP, Dubey S, Ray BK. Cortical Blindness and Moyamoya Angiopathy in the Context of an Acute COVID-19 Infection. J Neuroophthalmol 2024; 44:e172-e173. [PMID: 36166773 DOI: 10.1097/wno.0000000000001633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Shambaditya Das
- Department of Neurology (SD), Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India; Department of Neurology (AC), Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India; Department of Neurology (SD), Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India; and Department of Neurology (BKR), Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India
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Slingerland AL, Keusch DS, Lehman LL, Smith ER, Srivastava S, See AP. Yield of genetic evaluation in non-syndromic pediatric moyamoya patients. Childs Nerv Syst 2024; 40:801-808. [PMID: 37778001 DOI: 10.1007/s00381-023-06167-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Few guidelines exist for genetic testing of patients with moyamoya arteriopathy. This study aims to characterize the yield of genetic testing of non-syndromic moyamoya patients given the current pre-test probability. METHODS All pediatric moyamoya patients who received revascularization surgery at one institution between 2018 and 2022 were retrospectively reviewed. Patients with previously diagnosed moyamoya syndromes or therapeutic cranial radiation were excluded. RESULTS Of 117 patients with moyamoya, 74 non-syndromic patients (44 females, 59%) were eligible. The median age at surgery was 8.1 years. Neurosurgeons referred 18 (24%) patients for neurogenetic evaluation. Eleven (61%) patients subsequently underwent genetic testing. Eight (73%) patients had available testing results. Five (62.5%) of these patients had developmental delay compared to 16 (22%) of the entire cohort. Six (75%) patients who underwent genetic testing were found to have at least one genetic variant. These results led to diagnosis of a new genetic disorder for 1 (12.5%) patient and screening recommendations for 2 (25%) patients. An RNF213 variant in one patient led to recommendations for family member screening and pulmonary hypertension screening. Another patient was diagnosed with CBL disorder and referred for cancer screening. The median age at surgery in patients with clinically actionable findings was 4.6 years compared to 9.2 years in those who were referred for genetic testing. All 3 patients who had an actionable finding had developmental delay. CONCLUSION It may be beneficial to refer moyamoya patients under 5 for genetic screening given the high likelihood of discovering actionable mutations.
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Affiliation(s)
- Anna L Slingerland
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Dylan S Keusch
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Laura L Lehman
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward R Smith
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Siddharth Srivastava
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alfred P See
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
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Panda SK, Kundu A, Kumar Das M, Kumar Behera C. Severe Retinopathy of Prematurity and Moyamoya Disease- A Possible Association. Indian J Pediatr 2024; 91:208. [PMID: 37775608 DOI: 10.1007/s12098-023-04868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Santosh Kumar Panda
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, Odisha, India.
| | - Aheli Kundu
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, Odisha, India
| | - Manmath Kumar Das
- Department of Ophthalmology, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, Odisha, India
| | - Chinmay Kumar Behera
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, Odisha, India
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Scrimshaw L, Gorman K, Mansour S, Ganesan V, Sabir A. Moyamoya disease/cerebral vasculopathy in osteopathia striata with cranial sclerosis: a rare but important complication. Clin Dysmorphol 2024; 33:31-37. [PMID: 38037992 DOI: 10.1097/mcd.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Osteopathia striata with cranial sclerosis (OSCS) is a rare X-linked dominant sclerosing osteodysplasia, due to AMER1 pathogenic variants. Characteristic features include craniofacial sclerosis and long-bone metaphyseal striations. Moyamoya disease (a type of progressive cerebral vasculopathy) and other types of cerebral vascular disease are not currently clearly associated with OSCS (except for two separate case reports), and can often first present with stroke. Through informal networks with UK-based bone experts and the UK skeletal dysplasia group, three cases from the UK and Ireland were identified. Medical literature was also reviewed to identify the known cases of OSCS with the described complications. We report four females, in whom OSCS and cerebral vasculopathy co-exist, with varying clinical outcomes. There appears to be an emerging association between OSCS and cerebral vasculopathy, which pre-disposes patients to stroke. Given this, screening OSCS patients for cerebral vasculopathy may be of value, especially pre-surgery. Further research regarding optimal screening and management is needed. The mechanism of cerebral vasculopathy and its progression remain unclear.
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Affiliation(s)
- Lucy Scrimshaw
- Birmingham Children's Hospital, Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
| | - Kathleen Gorman
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Sahar Mansour
- Molecular and Clinical Sciences Research Institute, St. George's University of London
- South West Thames Centre for Genomics, St. George's University Hospitals NHS Foundation Trust
| | - Vijeya Ganesan
- Neurology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London
| | - Ataf Sabir
- Birmingham Children's Hospital, Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
- West Midlands Regional Clinical Genetics Unit, Birmingham Women's and Children's NHS FT
- Institute of Cancer and Genomics, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Wang Q, Yao Q, Yuan S, Shen Y, Feng Y, Liu L, Zhu Y, Zhao Y, Cui J, Qin J, Tian J, Zhao R, Liu L, Zhou Y, Liu X. Recurrent Cerebral Infarction Due to Moyamoya Disease Complicated With Systemic Lupus Erythematosus: A Case Report and Literature Review. Neurologist 2024; 29:4-13. [PMID: 37582681 DOI: 10.1097/nrl.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
INTRODUCTION We report a rare case of moyamoya disease caused by an RNF213 mutation, complicated with systemic lupus erythematosus. CASE REPORT A 32-year-old woman experienced 4 cerebral ischemia stroke events within 6 months. The main symptom was left limb weakness with blurred vision in the right eye. Results of digital subtraction angiography conducted at another hospital were consistent with moyamoya disease. On genetic testing, we found that the patient carried 2 mutations in the moyamoya disease-related gene RNF213 (p.R4810K, p.T1727M). On the basis of the laboratory immunologic indicators, such as positive antibodies and abnormal immunoglobulin levels and imaging examinations, the patient was finally diagnosed as moyamoya disease complicated with systemic lupus erythematosus. She was treated with aspirin, butylphthalide, urinary kallidinogenase, and sodium methylprednisolone. CONCLUSIONS This was a 32-year-old young patient diagnosed with moyamoya disease carrying RNF213 gene mutation and accompanied by lupus with cerebral ischemic event as the first occurrence. The patient's condition was complex; therefore, comprehensive analysis and in-depth consideration were needed to avoid a missed diagnosis and misdiagnosis. When the primary disease cannot be identified, genetic testing can help to clarify the diagnosis of moyamoya disease.
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Affiliation(s)
- Qisong Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Lim SS, Park S, Oh BH, Jung K, Bae JW, Bae DH. RNF213 vasculopathy manifested in various forms within a family: A case report. Medicine (Baltimore) 2023; 102:e36627. [PMID: 38115307 PMCID: PMC10727589 DOI: 10.1097/md.0000000000036627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
RATIONALE The ring finger protein 213 (RNF213) p.R4810K variant has been identified as being associated with Moyamoya disease (MMD), a condition that is more prevalent in East Asians. This association extends beyond cerebral vessels and has been implicated in coronary artery disease. PATIENT CONCERNS A 36-year-old female was admitted to the emergency room with chest pain. Although the patient had no known underlying conditions or risk factors for atherosclerosis, she was diagnosed with unstable angina and underwent percutaneous coronary intervention. Given her older sister's ongoing treatment for MMD, it was suspected that the patient's coronary artery disease might be linked to the MMD-associated gene mutation. DIAGNOSES Coronary angiography revealed 80% narrowing of the proximal left anterior descending artery. Based on clinical symptoms and coronary angiography, we diagnosed it as unstable angina. INTERVENTION Due to the family history of MMD and detection of the RNF213 p.R4810K heterozygous variant in the patient's older sister, genetic counseling was recommended. Next-generation sequencing for vascular diseases was performed. OUTCOMES Genetic testing confirmed the presence of an RNF213 p.R4810K heterozygous variant in the patient, mirroring that in her sister. An RNF213 p.C4397R heterozygous variant was identified concomitantly, although it was categorized as a variant of uncertain significance. Coronary artery disease has been attributed to the RNF213 p.R4810K variant. LESSONS Although MMD is rare in Western populations, it is more common in East Asian populations. Traditionally, MMD diagnoses have focused solely on the cerebral vessels without guidelines for the assessment of other vascular involvements. This familial case underscores the fact that a single genetic mutation can manifest in diverse ways in different diseases. Hence, the need and regularity of systemic vessel screening should be thoughtfully considered in such a context.
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Affiliation(s)
- Seong-Soo Lim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Sangshin Park
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Byeong Ho Oh
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Kiwook Jung
- Department of Laboratory Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Dae-Hwan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
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Helmy M, Liao Y, Luo S, Xu B. How I do it: direct pressure measurement in moyamoya bypass. Acta Neurochir (Wien) 2023; 165:3631-3635. [PMID: 37870662 DOI: 10.1007/s00701-023-05842-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The direct quantitative measurement of donor and recipient pressures in patients with moyamoya vasculopathy (MMV) during superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery has yet to be reported in academic literature. METHOD Using a wireless pressure wire, we describe our approach to measuring seven pressure parameters in MMV patients step-by-step. CONCLUSION Direct intraluminal pressure measurement of donor and recipient arteries provides a practical and accurate means to quantify cerebral hemodynamic parameters in MMV patients, enhancing understanding of individualized hemodynamic changes pre- and post-surgery.
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Affiliation(s)
- Mohamed Helmy
- Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, 200040, China
- China National Center of Neurological Diseases, Shanghai, 200040, China
| | - Yujun Liao
- Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, 200040, China
- China National Center of Neurological Diseases, Shanghai, 200040, China
| | - Siliang Luo
- Department of Neurosurgery, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, Guangdong, China
| | - Bin Xu
- Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, 200040, China.
- China National Center of Neurological Diseases, Shanghai, 200040, China.
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Chen T, Wei W, Zhang J, Yu J, Xu S, Wu D, Li X, Chen J. Assessment of plasma soluble Tie-2 level to distinguish moyamoya disease from atherosclerotic cerebrovascular disease and predict postoperative neovascularization. J Neurosurg 2023; 139:1705-1714. [PMID: 37347656 DOI: 10.3171/2023.4.jns23479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/26/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Moyamoya disease (MMD) is a chronic steno-occlusive cerebrovascular disease and features the formation of hazy collateral vessels at the base of the brain. Angiopoietin (Ang)-1 and -2, their receptor Tie-2, and vascular endothelial growth factor (VEGF) that regulate angiogenesis might be important in MMD pathophysiology and postoperative collateral formation. The goal of this study was to determine whether levels of these angiogenic factors could predict collateralization in patients with MMD. METHODS A total of 196 patients with MMD and 57 with atherosclerotic cerebrovascular disease serving as controls were enrolled. Ang-1, Ang-2, Tie-2, and VEGF mRNA levels were analyzed in middle cerebral artery (MCA) arterial wall specimens by using real-time quantitative polymerase chain reaction. MCA and peripheral plasma concentrations of Ang-1, Ang-2, soluble Tie-2 (sTie-2), and VEGF were examined by enzyme-linked immunosorbent assay. Cerebral arteriography was performed 6 months after bypass surgery to assess the postoperative collateralization. RESULTS In MCA specimens, patients with MMD exhibited higher expression levels of Ang-1 and Ang-2 but lowered VEGF expression. The patients with MMD had significantly higher concentrations of Ang-1 and Ang-2 but lower levels of VEGF in MCA plasma. Peripheral plasma concentrations of these growth factors were not changed. MCA and peripheral plasma sTie-2 levels were both reduced in patients with MMD. The 6-month follow-up showed that patients with good collateral formation had lower sTie-2 levels in both MCA and peripheral plasma. Furthermore, the Suzuki stage and peripheral plasma sTie-2 level were significantly correlated with good postoperative collateral formation on multivariate analysis. CONCLUSIONS Ang-1, Ang-2, Tie-2, and VEGF are involved in MMD pathogenesis. The peripheral plasma level of sTie-2 can differentiate MMD from atherosclerotic cerebrovascular disease and serve as a novel biomarker to predict postoperative collateral formation.
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Affiliation(s)
- Tongyu Chen
- 1Department of Neurosurgery, Zhongnan Hospital of Wuhan University; and
| | - Wei Wei
- 1Department of Neurosurgery, Zhongnan Hospital of Wuhan University; and
- 2Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jianjian Zhang
- 1Department of Neurosurgery, Zhongnan Hospital of Wuhan University; and
| | - Jin Yu
- 1Department of Neurosurgery, Zhongnan Hospital of Wuhan University; and
| | - Shuangxiang Xu
- 1Department of Neurosurgery, Zhongnan Hospital of Wuhan University; and
| | - Du Wu
- 1Department of Neurosurgery, Zhongnan Hospital of Wuhan University; and
| | - Xiang Li
- 1Department of Neurosurgery, Zhongnan Hospital of Wuhan University; and
- 2Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jincao Chen
- 1Department of Neurosurgery, Zhongnan Hospital of Wuhan University; and
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13
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Kang J, Lee CN, Lin MW, Lin SY. Safe delivery planning of patients with moyamoya disease in pregnancy: Case series of a single center. Taiwan J Obstet Gynecol 2023; 62:918-920. [PMID: 38008516 DOI: 10.1016/j.tjog.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Moyamoya disease (MMD) is a rare cerebral vascular disease and there is limited clinical experience for pregnant women. Cerebrovascular condition might deteriorated during pregnancy. Management and mode of delivery is challenging for obstetrics specialist. CASE REPORT Three cases of parturients with moyamoya disease delivered in National Taiwan University Hospital are presented. All were previously diagnosed and one had stroke incidence before current pregnancy course. Two delivered with Cesarean section and one with vaginal delivery, and all delivered at term without maternal or neonatal complication. CONCLUSION Although delivery method of parturients with MMD has been debating, vaginal delivery may be suitable for certain cases under adequate monitoring and case selection.
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Affiliation(s)
- Jessica Kang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Wei Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Shin-Yu Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
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14
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Ding YH, Chen JY, Zheng ES, Wang ZQ, Liang RS, Shi SS, Tu XK. Clinical features, surgical treatment, and long-term outcomes of moyamoya disease in a single institution of Fujian, Southeast China: A retrospective study. Medicine (Baltimore) 2023; 102:e35684. [PMID: 37904447 PMCID: PMC10615558 DOI: 10.1097/md.0000000000035684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023] Open
Abstract
At present, detailed demographic and clinical data of moyamoya disease (MMD) in the population of Southeast China are lacking. Therefore, this study aimed to evaluate the epidemiological and clinical features of MMD in Southeast China. Our cohort included 170 patients diagnosed with MMD over the preceding 5 years. Clinical characteristics were obtained through a retrospective chart review, while follow-up information and outcomes were obtained through clinical visits and imaging. The median age at symptom onset was 49 years (range 4-73), with a peak in the age distribution observed at 41 to 60 years. The female-to-male ratio was 1.125 (90/80), and the ratio of the ischemic type to the hemorrhagic type was 2.33 (119/50). The most common initial symptom was an ischemic event. The 5-year Kaplan-Meier risk of stroke was 4.9% for all patients treated with surgical revascularization. Of all patients, 83.9% were able to live independently with no significant disability, and 89.8% showed improved cerebral hemodynamics. Our study provided detailed demographic and clinical data on Southeastern Chinese patients with MMD, which was consistent with findings in other parts of China. Raising clinical awareness of MMD in primary hospitals is important to facilitate early diagnosis and timely treatment of MMD patients.
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Affiliation(s)
- Yi-hang Ding
- , Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jing-yi Chen
- , Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - En-shuang Zheng
- , Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zi-qing Wang
- , Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ri-sheng Liang
- , Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Song-sheng Shi
- , Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xian-kun Tu
- , Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
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15
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Gonzalez NR, Amin-Hanjani S, Bang OY, Coffey C, Du R, Fierstra J, Fraser JF, Kuroda S, Tietjen GE, Yaghi S. Adult Moyamoya Disease and Syndrome: Current Perspectives and Future Directions: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2023; 54:e465-e479. [PMID: 37609846 DOI: 10.1161/str.0000000000000443] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Adult moyamoya disease and syndrome are rare disorders with significant morbidity and mortality. A writing group of experts was selected to conduct a literature search, summarize the current knowledge on the topic, and provide a road map for future investigation. The document presents an update in the definitions of moyamoya disease and syndrome, modern methods for diagnosis, and updated information on pathophysiology, epidemiology, and both medical and surgical treatment. Despite recent advancements, there are still many unresolved questions about moyamoya disease and syndrome, including lack of unified diagnostic criteria, reliable biomarkers, better understanding of the underlying pathophysiology, and stronger evidence for treatment guidelines. To advance progress in this area, it is crucial to acknowledge the limitations and weaknesses of current studies and explore new approaches, which are outlined in this scientific statement for future research strategies.
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16
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Takahashi S, Katsumata M, Mizuguchi Y, Toda M. A case of moyamoya disease diagnosed as cerebral infarction in the early postpregnancy period and surgically treated by bilateral revascularization after term delivery. Clin Neurol Neurosurg 2023; 231:107859. [PMID: 37390571 DOI: 10.1016/j.clineuro.2023.107859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/02/2023]
Abstract
We treated a 37-year-old Japanese woman with moyamoya disease who developed cerebral infarction in the early period after pregnancy and had undergone infertility treatment. After being adequately informed, including regarding the risk of stroke in the perinatal period and the option to prioritize the treatment of moyamoya disease even if the pregnancy was interrupted, the patient decided to continue the pregnancy and underwent surgical treatment after a full-term delivery by caesarean section. No new stroke was observed throughout the perinatal period or postoperative course. Since serious stroke during the perinatal period has also been reported in moyamoya disease, it is important to plan "tailored" treatment by sufficiently informing patients considering individual backgrounds and for multiple medical departments, including obstetrics, neurology, and neurosurgery departments, to carry out close outpatient follow-up in the perinatal period and carefully careful medication usage and radiological examinations.
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Affiliation(s)
- Satoshi Takahashi
- Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan.
| | - Masahiro Katsumata
- Department of Neurology, Keio University, School of Medicine, Tokyo, Japan
| | - Yuki Mizuguchi
- Department of Obstetrics and Gynecology, Keio University, School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan
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17
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Kaseka ML, Dlamini N. Investigation and management of pediatric moyamoya arteriopathy in the era of genotype-phenotype correlation studies. Eur J Hum Genet 2023; 31:735-737. [PMID: 37188827 PMCID: PMC10326028 DOI: 10.1038/s41431-023-01369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- M L Kaseka
- Division of Neurology, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
| | - N Dlamini
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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18
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Ishiyama H, Ihara M. Uncovering the genetic architecture of paediatric moyamoya angiopathy: implications for disease pathogenesis. Eur J Hum Genet 2023; 31:733-734. [PMID: 37020136 PMCID: PMC10326050 DOI: 10.1038/s41431-023-01353-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Affiliation(s)
- Hiroyuki Ishiyama
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
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19
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Fujioka M, Hara S, Mukawa M, Karakama J, Inaji M, Tanaka Y, Nariai T, Maehara T. Changes in the clinical spectrum of pediatric moyamoya disease over 40 years. Childs Nerv Syst 2023; 39:1215-1223. [PMID: 36790492 DOI: 10.1007/s00381-023-05852-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/14/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To investigate the chronological changes in the clinical presentation and long-term prognosis of pediatric-onset moyamoya disease in our institute over 40 years. METHODS We evaluated 282 pediatric-onset (≤ 15 years old) moyamoya disease patients who visited our institute from 1981 to 2020 (divided into the former period, 1981-2000, and the latter period, 2001-2020). Differences in the clinical presentation and the long-term outcome were compared between the periods. Multivariate analysis was also performed to reveal the risk factors for poor long-term outcomes. RESULTS Compared to the former period, the total number of patients, the onset age and both the number of patients with family history and relatively older patients without symptoms or with headache were greater in the latter period (p < 0.05). The number of patients with poor long-term outcomes was significantly lower in the latter period (24.9% vs. 6.7%, p < 0.01). Multivariate analysis revealed that stroke onset, late cerebrovascular events and postoperative complications were independent risk factors for poor long-term outcomes (odds ratio = 31.4, 40.8 and 5.4, respectively). CONCLUSIONS Over the last 40 years, the number of pediatric moyamoya disease patients has increased, especially in relatively older patients with mild presentation and favorable long-term outcomes. In clinical studies, these chronological changes and the inclusion period of the participants need to be accounted for. Whether the increased diagnostic rate in the recent era has led to a decrease in late cerebrovascular events and favorable outcomes throughout life remains unknown and should be evaluated in the future.
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Affiliation(s)
- Mai Fujioka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Maki Mukawa
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Karakama
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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20
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Hiruma M, Watanabe N, Mitsumatsu T, Suzuki N, Fukushita M, Matsumoto M, Yoshihara A, Yoshimura Noh J, Sugino K, Ito K. Clinical features of moyamoya disease with Graves' disease: a retrospective study of 394,422 patients with thyroid disease. Endocr J 2023; 70:141-148. [PMID: 36198616 DOI: 10.1507/endocrj.ej22-0319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Graves' disease has been reported to affect the clinical features of moyamoya disease (MMD), an occlusion of the circle of Willis. This study aimed to clarify the characteristics of MMD in patients with Graves' disease. This was a single-center, retrospective study. The prevalence and clinical features of MMD patients among all patients with thyroid disease who visited Ito Hospital from January 2005 to December 2019 were evaluated. The relationship between MMD and hyperthyroidism was analyzed in new-onset Graves' disease patients during the same period. Of all 394,422 patients with thyroid disease, 88,180 had Graves' disease, and 40 had MMD with Graves' disease, i.e., the prevalence was 45.36 per 100,000 patients with Graves' disease (0.0454%). The median age at onset of MMD was 39 years (interquartile range, 31-54 years), with a male to female ratio of 1:12. The most common time that MMD was diagnosed was within 1 year after the onset of Graves' disease, in 9 of 40 patients (22.5%), and 19 of 40 patients (47.5%) underwent bypass surgery for MMD. In MMD with Graves' disease, headache was the most frequent symptom, and ischemic types of stroke and bilateral lesions were common. Of 23,347 patients with new-onset Graves' disease, 7 were diagnosed with MMD and the incidence of MMD was 5.94 patients per 100,000 person-years. Most patients developed MMD symptoms during hyperthyroidism. Although MMD is a rare condition, it should be noted that it can occur with Graves' disease.
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Affiliation(s)
- Marino Hiruma
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo 143-8541, Japan
| | - Natsuko Watanabe
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
| | - Takako Mitsumatsu
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
| | - Nami Suzuki
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
| | - Miho Fukushita
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
| | - Masako Matsumoto
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
| | - Ai Yoshihara
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
| | | | | | - Koichi Ito
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
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21
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Dong XY, Yang J, Yang CH. The effect of dilated cardiomyopathy with moyamoya disease in a 31-year-old Chinese man: A case report. Medicine (Baltimore) 2022; 101:e31675. [PMID: 36550853 PMCID: PMC9771247 DOI: 10.1097/md.0000000000031675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is a clinically common and refractory disease; however, few cases of dilated cardiomyopathy have been reported in patients with moyamoya diseases treated by combining traditional Chinese Medicine (TCM) and Western medicine, which has a higher risk of rehabilitation. CASE SUMMARY A 31-year-old man was admitted due to paroxysmal chest tightness and shortness of breath. He denied a history of DCM, hypertension, diabetes, pericarditis, smoking, and alcohol consumption. On admission, his transesophageal echocardiography (Fig. 1A) showed the larger heart with poor myocardial systolic function (left ventricular end diastolic diameter [LVEDd] 60 mm, left ventricular ejection fraction [LVEF] 38% [Teich]). On day 14 of admission, heart-related indicators were better than before. CONCLUSION The present case is the first report demonstrating appearance the dilated cardiomyopathy (DCM) and moyamoya disease simultaneously in a 31-year-old Chinese man, aimed to report the treatment of such patients using a combination of TCM and Western medicine and analyzing the necessity and advantages of using this treatment for patients suffering from DCM and moyamoya disease, so as to improve the level of clinical diagnosis and treatment of such diseases.
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Affiliation(s)
- Xia Yun Dong
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jie Yang
- Department of cardiovascular medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- * Correspondence: Jie Yang, Department of Cardiovascular Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 16369, Jingshi Road, Lixia District, Jinan 250011, China (e-mail: )
| | - Chuan Hua Yang
- Department of cardiovascular medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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22
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Kimiwada T, Hayashi T, Shirane R, Tominaga T. [Moyamoya Disease in Infants and Toddlers]. No Shinkei Geka 2022; 50:1256-1263. [PMID: 36426527 DOI: 10.11477/mf.1436204693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Treatment for moyamoya disease in infants and toddlers is challenging, because of the progressiveness of the disease. Revascularization surgery is the first-line therapy and should be performed as early as possible after diagnosis to prevent additional cerebral infarction. This review describes in detail the changes in the new "Diagnostic Criteria 2021 for moyamoya disease", and discusses the concept of treatment including indirect and combined bypass surgery in infants and toddlers. Surgical technique and perioperative management based on our experience are also precisely described.
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Rose DK, Chamberlain L, Ashton J, Yaghi S, Hauck EF, Mac Grory B. Moyamoya syndrome in a young person with Down syndrome: diagnostic and therapeutic considerations. BMJ Case Rep 2022; 15:e246168. [PMID: 35246432 PMCID: PMC8900050 DOI: 10.1136/bcr-2021-246168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
An 18-year-old woman with a history of Down syndrome (DS) presented with left upper extremity weakness. Neurological examination revealed moderate hypotonia throughout, with mild spasticity of the left ankle. She had 2/5 left upper and lower extremity strength, mild pronation with drift in the left arm and 3+ deep tendon reflexes in the left biceps, brachioradialis, patellar and Achilles. Strength was 5/5 in the right upper and lower extremities. A CT angiography of the head and neck with contrast demonstrated severe narrowing of the bilateral supraclinoid internal carotid arteries (ICAs), suggestive of moyamoya pattern. A diagnostic angiography confirmed stenosis in the right and left supraclinoid ICAs. The patient was started on aspirin therapy and underwent an indirect bypass procedure via encephaloduroarteriosynangiosis 6 weeks after initial presentation. DS is associated with a high risk of congenital heart disease, which in turn increases risk of stroke, namely cardioembolic events, including moyamoya disease. Intellectual disability is nearly ubiquitous in DS, thus adding to the challenges of making a diagnosis of moyamoya in this population.
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Affiliation(s)
- Deborah Kathleen Rose
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lauren Chamberlain
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jeffrey Ashton
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Erik F Hauck
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brian Mac Grory
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
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25
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Bernson-Leung ME, Rapalino O, Walker MA, Butler WE. Case 40-2021: A 9-Year-Old Boy with Transient Weakness, Facial Droop, and Slurred Speech. N Engl J Med 2021; 385:2563-2572. [PMID: 34965341 DOI: 10.1056/nejmcpc2107358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Miya E Bernson-Leung
- From the Department of Neurology, Boston Children's Hospital (M.E.B.-L.), the Departments of Neurology (M.E.B.-L., M.A.W.), Radiology (O.R.), and Neurosurgery (W.E.B.), Harvard Medical School, and the Departments of Radiology (O.R.), Neurology (M.A.W.), and Neurosurgery (W.E.B.), Massachusetts General Hospital - all in Boston
| | - Otto Rapalino
- From the Department of Neurology, Boston Children's Hospital (M.E.B.-L.), the Departments of Neurology (M.E.B.-L., M.A.W.), Radiology (O.R.), and Neurosurgery (W.E.B.), Harvard Medical School, and the Departments of Radiology (O.R.), Neurology (M.A.W.), and Neurosurgery (W.E.B.), Massachusetts General Hospital - all in Boston
| | - Melissa A Walker
- From the Department of Neurology, Boston Children's Hospital (M.E.B.-L.), the Departments of Neurology (M.E.B.-L., M.A.W.), Radiology (O.R.), and Neurosurgery (W.E.B.), Harvard Medical School, and the Departments of Radiology (O.R.), Neurology (M.A.W.), and Neurosurgery (W.E.B.), Massachusetts General Hospital - all in Boston
| | - William E Butler
- From the Department of Neurology, Boston Children's Hospital (M.E.B.-L.), the Departments of Neurology (M.E.B.-L., M.A.W.), Radiology (O.R.), and Neurosurgery (W.E.B.), Harvard Medical School, and the Departments of Radiology (O.R.), Neurology (M.A.W.), and Neurosurgery (W.E.B.), Massachusetts General Hospital - all in Boston
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26
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Slingerland AL, Karsten MB, Smith ER, Sobota AE, See AP. Two Sides of a Coin: Case Report of Unilateral Synangiosis and Contralateral Stroke Highlighting Consequences of Disease Progression and Efficacy of Revascularization in Sickle Cell Disease Associated Moyamoya Syndrome. Acta Haematol 2021; 145:458-464. [PMID: 34879377 DOI: 10.1159/000521361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022]
Abstract
Moyamoya syndrome increases the risk of stroke in sickle cell disease, but revascularization surgery can modify this risk. Collaborative management between hematology and neurosurgery offers effective strategies to reduce stroke risk in these patients. We describe a challenging case where a patient with sickle cell disease undergoing standard of care management as prescribed by the Stroke Prevention Trial in Sickle Cell Anemia (STOP) and revascularization with pial synangiosis subsequently developed rapidly progressive disease in other cerebral vessels and suffered ischemic hemispheric stroke. This case demonstrates the success of management in accordance with American Heart Association (AHA) and American Stroke Association (ASA) guidelines, but also demonstrates critical areas where we lack understanding of disease progression.
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Affiliation(s)
- Anna L Slingerland
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Madeline B Karsten
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Edward R Smith
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amy E Sobota
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alfred P See
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Wu HH, Shen JY, Wang YH, Tzeng NS, Wan FJ, Lai HC, Chen TY. A rare presentation of moyamoya disease mimicking schizophrenia: A case report. Asian J Psychiatr 2021; 65:102818. [PMID: 34509899 DOI: 10.1016/j.ajp.2021.102818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Hung-Hsi Wu
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Jia-Ying Shen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Hsuan Wang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Fang-Jung Wan
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Hsiao-Ching Lai
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
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Murai Y, Ishisaka E, Watanabe A, Sekine T, Shirokane K, Matano F, Nakae R, Tamaki T, Koketsu K, Morita A. RNF213 c.14576G>A Is Associated with Intracranial Internal Carotid Artery Saccular Aneurysms. Genes (Basel) 2021; 12:genes12101468. [PMID: 34680863 PMCID: PMC8535736 DOI: 10.3390/genes12101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
A mutation in RNF213 (c.14576G>A), a gene associated with moyamoya disease (>80%), plays a role in terminal internal carotid artery (ICA) stenosis (>15%) (ICS). Studies on RNF213 and cerebral aneurysms (AN), which did not focus on the site of origin or morphology, could not elucidate the relationship between the two. However, a report suggested a relationship between RNF213 and AN in French-Canadians. Here, we investigated the relationship between ICA saccular aneurysm (ICA-AN) and RNF213. We analyzed RNF213 expression in subjects with ICA-AN and atherosclerotic ICS. Cases with a family history of moyamoya disease were excluded. AN smaller than 4 mm were confirmed as AN only by surgical or angiographic findings. RNF213 was detected in 12.2% of patients with ICA-AN and 13.6% of patients with ICS; patients with ICA-AN and ICS had a similar risk of RNF213 mutation expression (odds ratio, 0.884; 95% confidence interval, 0.199-3.91; p = 0.871). The relationship between ICA-AN and RNF213 (c.14576G>A) was not correlated with the location of the ICA and bifurcation, presence of rupture, or multiplicity. When the etiology and location of AN were more restricted, the incidence of RNF213 mutations in ICA-AN was higher than that reported in previous studies. Our results suggest that strict maternal vessel selection and pathological selection of AN morphology may reveal an association between genetic mutations and ICA-AN development. The results of this study may form a basis for further research on systemic vascular diseases, in which the RNF213 (c.14576G>A) mutation has been implicated.
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Affiliation(s)
- Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo 1138603, Japan; (E.I.); (K.S.); (F.M.); (K.K.); (A.M.)
- Correspondence: ; Tel.: +81-3-3822-2131
| | - Eitaro Ishisaka
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo 1138603, Japan; (E.I.); (K.S.); (F.M.); (K.K.); (A.M.)
| | - Atsushi Watanabe
- Division of Clinical Genetics, Kanazawa University Hospital, Kanazawa 9208640, Japan;
- Support Center for Genetic Medicine, Kanazawa University Hospital, Kanazawa 9208640, Japan
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa 2118533, Japan;
| | - Kazutaka Shirokane
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo 1138603, Japan; (E.I.); (K.S.); (F.M.); (K.K.); (A.M.)
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo 1138603, Japan; (E.I.); (K.S.); (F.M.); (K.K.); (A.M.)
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo 1138603, Japan;
| | - Tomonori Tamaki
- Department of Neurosurgery, Nippon Medical School Tama Nagayama Hospital, Tama, Tokyo 2068512, Japan;
| | - Kenta Koketsu
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo 1138603, Japan; (E.I.); (K.S.); (F.M.); (K.K.); (A.M.)
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo 1138603, Japan; (E.I.); (K.S.); (F.M.); (K.K.); (A.M.)
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Seong HJ, Lee JH, Heo JH, Kim DS, Kim YB, Lee CS. CLINICAL SIGNIFICANCE OF RETINAL VASCULAR OCCLUSION IN MOYAMOYA DISEASE: Case Series and Systematic Review. Retina 2021; 41:1791-1798. [PMID: 33840794 DOI: 10.1097/iae.0000000000003181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Although moyamoya disease primarily affects the carotid artery in the ophthalmic artery bifurcation area, retinal vascular abnormalities in moyamoya disease have rarely been reported. The purpose of this report is to describe clinical findings of patients with retinal vascular occlusion in patients with moyamoya disease and present its clinical significance. METHODS We reviewed and analyzed patients with moyamoya disease with retinal vascular occlusions. For this, a retrospective medical chart review was performed in a tertiary medical center and a literature search was performed using PubMed and EMBASE until September 2020. RESULTS Patients with retinal artery occlusion (RAO) were significantly younger than patients with retinal vein occlusion (25.0 vs. 40.1 years, P = 0.023). Of 14 patients, retinal vascular occlusion was the presenting sign of moyamoya disease in 8 (57.1%) patients. The occlusion site at the carotid artery was proximal to the ophthalmic artery bifurcation area in 8 (57.1%) patients. Legal blindness occurred in 8 (57.1%) patients at final visits. CONCLUSION Retinal vascular occlusion is a rare but sight-threatening ocular complication in patients with moyamoya disease. Overall, younger age may be a risk factor for RAO, whereas older age for retinal vein occlusion. Retinal vascular occlusion can be an important indicator of moyamoya disease screening, especially in relatively younger and healthy patients.
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Affiliation(s)
- Hyo Jin Seong
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Hwan Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoe Heo
- Department of Neurology, Severance Stroke Center, Yonsei University College of Medicine, Seoul, Republic of Korea; and
| | - Dong Seok Kim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Bae Kim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Teng CH, Yang IH, Wu MN, Chou PS. Posterior reversible encephalopathy syndrome (PRES) in a patient with moyamoya disease: A case report. Medicine (Baltimore) 2021; 100:e26837. [PMID: 34397851 PMCID: PMC8341325 DOI: 10.1097/md.0000000000026837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/19/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Moyamoya disease (MMD) and posterior reversible encephalopathy syndrome (PRES) share similar pathophysiological characteristics of endothelial dysfunction and impaired cerebral autoregulation. However, there have never been any published studies to demonstrate the relationship between these 2 rare diseases. PATIENT CONCERNS A 26-year-old Asian man presented with a throbbing headache, blurred vision, and extremely high blood pressure. We initially suspected acute cerebral infarction based on the cerebral computed tomography, underlying MMD, and prior ischemic stroke. However, the neurological symptoms deteriorated progressively. DIAGNOSIS Cerebral magnetic resonance imaging indicated the presence of vasogenic edema rather than cerebral infarction. INTERVENTIONS AND OUTCOMES An appropriate blood pressure management prevents the patient from disastrous outcomes successfully. Cerebral magnetic resonance imaging at 2 months post treatment disclosed the complete resolution of cerebral edema. The patient's recovery from clinical symptoms and the neuroimaging changes supported the PRES diagnosis. CONCLUSION This report suggests that patients with MMD may be susceptible to PRES. It highlights the importance of considering PRES as a differential diagnosis while providing care to MMD patients with concurrent acute neurological symptoms and a prompt intervention contributes to a favorable clinical prognosis.
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Affiliation(s)
- Chun-Hsin Teng
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Hsiao Yang
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Ni Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of and Master's Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Song Chou
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of and Master's Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
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Oh WO, Yeom I, Lim SH, Kim DS, Shim KW. The Moyamoya Health Behavior Scale for Adolescent Patients: Measurement Tool Development and Psychometric Evaluation. Int J Environ Res Public Health 2021; 18:ijerph18084064. [PMID: 33921478 PMCID: PMC8070576 DOI: 10.3390/ijerph18084064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022]
Abstract
Clinical practitioners treating moyamoya disease recognize the need for a systematic approach to better manage the disease in adolescent patients with the disease. Methods: This study aimed to develop and evaluate the validity and reliability of a disease scale which measures the health-related behaviors of adolescents with moyamoya disease. Results: The final 12-item Moyamoya-HB Scale for adolescents was categorized by three sub-domains: implementation of treatment for moyamoya disease (four items); health promoting behavior for moyamoya disease (four items); and health coping behavior for moyamoya disease (four items). Overall, these factors explained 68.97% of the total variance. The results of the confirmative factor analysis supported the construct, convergent and discriminant validity of the three sub-domains. The Moyamoya-HB Scale for adolescents also demonstrated a concurrent validity with the Korean Adolescents’ Health Behaviors Tool (r = 0.59, p < 0.001). Reliability analysis showed an acceptable-to-high Cronbach’s alpha of 0.865 in total, and the subscales ranged from 0.800 to 0.841. Conclusions: Initial findings support the Moyamoya-HB Scale as a reliable and valid measure of health behaviors in adolescents with moyamoya disease.
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Affiliation(s)
- Won-oak Oh
- College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02481, Korea; (W.-o.O.); (S.-H.L.)
| | - Insun Yeom
- Department of Pediatric Neurosurgery, Severance Children’s Hospital, Yonsei University Health System, 50-1 Yeonse-ro, Seodaemun-gu, Seoul 03722, Korea; (D.-S.K.); (K.-w.S.)
- Correspondence:
| | - Sung-Hyun Lim
- College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02481, Korea; (W.-o.O.); (S.-H.L.)
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Children’s Hospital, Yonsei University Health System, 50-1 Yeonse-ro, Seodaemun-gu, Seoul 03722, Korea; (D.-S.K.); (K.-w.S.)
| | - Kyu-won Shim
- Department of Pediatric Neurosurgery, Severance Children’s Hospital, Yonsei University Health System, 50-1 Yeonse-ro, Seodaemun-gu, Seoul 03722, Korea; (D.-S.K.); (K.-w.S.)
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Abstract
Ask-Upmark kidney (AUK) is a scarred segment of the kidney, characterized by formation of primitive tubular and glomerular structures, and sporadically diagnosed as a cause of hypertension (HTN). A 6-year-old girl with neurofibromatosis type 1 (NF1) and moyamoya syndrome had severe HTN. Based on past history, she had HTN at the age of 1.5 years. Laboratory examination revealed slightly elevated plasma and renal venous renin activity without lateralization. No evidence of pheochromocytoma, or coarctation of the aorta was found. Contrast-enhanced computed tomography (CT) showed an area of hypoperfusion in the upper and middle poles with reduced size of the right kidney. The results of dimercaptosuccinic acid scintigraphy were in accordance with those of contrast-enhanced CT. Selected renal arteriography revealed a paucity of peripheral vascularity in the same parts of the right kidney. In the absence of a history of urinary tract infection and vesicoureteral reflux by cystography, we presumed that the severe HTN may be due to segmental hypoplasia of the kidney, AUK, with a possible contribution from NF1. Although renal artery stenosis and pheochromocytoma are well-known causes of HTN in NF1, this case demonstrates that HTN can be caused by AUK in patients with NF1.
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Affiliation(s)
- Yuri Dote
- Department of Pediatrics, Seirei-Mikatahara General Hospital, 3453 Mikatahara, Hamamatsu, Shizuoka, 433-8558, Japan.
| | - Tetsuya Kibe
- Department of Pediatrics, Seirei-Mikatahara General Hospital, 3453 Mikatahara, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Tomotaka Murakami
- Department of Pediatrics, Seirei-Mikatahara General Hospital, 3453 Mikatahara, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Midori Awazu
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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Ebert JJ, Sisk RA. CRAO in Moyamoya Syndrome Associated With Southampton Hemoglobinopathy. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e166-e170. [PMID: 31100171 DOI: 10.3928/23258160-20190503-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/05/2018] [Indexed: 11/20/2022]
Abstract
The authors present the first case of central retinal artery occlusion (CRAO) resulting from moyamoya syndrome secondary to Southampton hemoglobinopathy. A 12-year-old Hispanic girl with a history of Southampton hemoglobinopathy with moyamoya syndrome presented with amaurosis fugax in her left eye that resolved within hours except for an inferior paracentral scotoma. She had left ophthalmic artery occlusion on magnetic resonance angiogram. Seven months later, spectral-domain optical coherence tomography showed diffuse inner retinal thinning. She was diagnosed with transient CRAO. The authors conclude that CRAO can result from moyamoya syndrome secondary to an underlying hemoglobinopathy. Multimodal imaging demonstrated residual inner retinal injury despite reperfusion. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e166-e170.].
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Cheng ZJ, Shen YY, Warsame IM, Dai TM, Tu JL. Moyamoya Syndrome Caused by Paroxysmal Nocturnal Hemoglobinuria. Chin Med J (Engl) 2018; 131:2874-2876. [PMID: 30511695 PMCID: PMC6278181 DOI: 10.4103/0366-6999.246065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 01/25/2023] Open
Affiliation(s)
- Zhi-Juan Cheng
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yao-Yao Shen
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi 332000, China
| | - Ishak Mohamed Warsame
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Ting-Min Dai
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi 332000, China
| | - Jiang-Long Tu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
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Liu Y, Wu X, Fan Z, Cheng J, Zhong L, Lin Y, Qu X. Development of atherosclerotic-moyamoya syndrome with genetic variant of RNF213 p.R4810K and p.T1727M: A case report. Clin Neurol Neurosurg 2018; 168:163-166. [PMID: 29567577 DOI: 10.1016/j.clineuro.2018.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/20/2018] [Accepted: 01/28/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We report a rare case of atherosclerotic-moyamoya syndrome (A-MMS) in an adult female with genetic variant of both ring finger 213 (RNF213) p.R4810K and p.T1727M. CASE REPORT A 46-year-old previously healthy, right-handed woman displayed transient slurred speech, which started to worsen four years ago. Initial magnetic resonance angiography (MRA) revealed stenosis in left middle cerebral artery (MCA), bilateral anterior cerebral artery (ACA), and left posterior cerebral artery (PCA). The patient subsequently underwent catheter angiography, which confirmed the formation of moyamoya vessels, with Suzuki's angiographic staging of grade-3 on the left side. Although the patient had been on both anti-platelet and statin therapy at the time, a follow-up examination showed further exacerbation of left MCA stenosis, along with enhanced moyamoya vessel formation. On black-blood imaging using DANTE-SPACE, there were eccentric, evolving lesions in the left MCA. We next screened for potential genetic variants, using genomic DNA samples isolated from both the patient and her immediate family members. The results showed that the patient, along with her mother, sister, and brother, possessed the heterozygous variant of the RNF213 gene, including c.14429G > A (p.R4810K) and c.5180C > T (p.T1727M). The patient's daughter did not have the variant. CONCLUSION Collectively, we present a unique case of A-MMS with genetic variant of RNF213 p.R4810K and p.T1727M, manifesting as progression. Based on the family tree, these two mutations are on the same RNF213 haplotype. Whether atherosclerosis is the cause of A-MMS or it further exacerbates the injury of MMD to the A-MMS patients with RNF213 gene variant is a question to be investigated.
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Affiliation(s)
- Ying Liu
- Department of Neurology, The Second Hospital of Dalian Medical University, China.
| | - Xueying Wu
- Department of Emergency, The Second Hospital of Dalian Medical University, China.
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States.
| | - Jingdan Cheng
- Department of Neurology, The Second Hospital of Dalian Medical University, China.
| | - Lele Zhong
- Department of Neurology, The Second Hospital of Dalian Medical University, China.
| | - Yongzhong Lin
- Department of Neurology, The Second Hospital of Dalian Medical University, China.
| | - Xiaofeng Qu
- Department of Radiology, The Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian, 116027, China.
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Lee ML, Chang MY, Chang TM, Yang RC, Chang MC, Yang AD. Revascularization of Concurrent Renal and Cerebral Artery Stenosis in a 14-Year-Old Girl with Takayasu Arteritis and Moyamoya Syndrome. J Korean Med Sci 2018; 33:e76. [PMID: 29495141 PMCID: PMC5832941 DOI: 10.3346/jkms.2018.33.e76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/08/2017] [Indexed: 11/20/2022] Open
Abstract
Concurrent involvement of bilateral renal and cerebral arteries, usually incurred as stenosis, is rare in childhood-onset Takayasu arteritis (c-TA). We report the case of a 14-year-old girl, with c-TA, presenting with transient ischemic attack after endovascular revascularization for renal artery stenosis and cerebrovascular stroke after surgical revascularization for cerebral artery stenosis associated with childhood-onset moyamoya syndrome. We deem that decrease of blood pressure by endovascular revascularization and improvement of cerebral perfusion by surgical revascularization may have jeopardized the cerebral deep watershed zone to cerebral ischemia followed by cerebral hyperperfusion syndrome and caused transient ischemic attack and cerebrovascular stroke in our patient. Revascularization could be a double-edge sword for c-TA patients presenting with concomitant renal artery stenosis and cerebral artery stenosis, and should be performed with caution. Quantitative analysis of cerebral blood flow by brain magnetic resonance imaging and angiography should be performed within 48 hours after surgical revascularization in c-TA.
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Affiliation(s)
- Meng Luen Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Ming Yuh Chang
- Division of Pediatric Neurology, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Tung Ming Chang
- Division of Pediatric Neurology, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Rei Cheng Yang
- Division of Pediatric Neurology, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Ming Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Albert D Yang
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
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Hoshino S, Tsuda E, Miyazaki A. Vasospastic angina and asymptomatic moyamoya disease in a 14-year-old girl. Pediatr Int 2018; 60:296-297. [PMID: 29480584 DOI: 10.1111/ped.13499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 10/10/2017] [Accepted: 11/28/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Shinsuke Hoshino
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Aya Miyazaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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Yamamoto T, Okada T, Fushimi Y, Yamamoto A, Fujimoto K, Okuchi S, Fukutomi H, Takahashi JC, Funaki T, Miyamoto S, Stalder AF, Natsuaki Y, Speier P, Togashi K. Magnetic resonance angiography with compressed sensing: An evaluation of moyamoya disease. PLoS One 2018; 13:e0189493. [PMID: 29351284 PMCID: PMC5774704 DOI: 10.1371/journal.pone.0189493] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022] Open
Abstract
Compressed sensing (CS) reconstructions of under-sampled measurements generate missing data based on assumptions of image sparsity. Non-contrast time-of-flight MR angiography (TOF-MRA) is a good candidate for CS based acceleration, as MRA images feature bright trees of sparse vessels over a well-suppressed anatomical background signal. A short scan time derived from CS is beneficial for patients of moyamoya disease (MMD) because of the frequency of MR scans. The purpose of this study was to investigate the reliability of TOF-MRA with CS in the evaluation of MMD. Twenty-two patients were examined using TOF-MRA with CS (CS-TOF) and parallel imaging (PI-TOF). The acceleration factors were 3 (CS3) and 5 (CS5) for CS-TOF, and 3 (PI3) for PI-TOF. Two neuroradiologists evaluated the MMD grading according to stenosis/occlusion scores using the modified Houkin’s system, and the visibility of moyamoya vessels (MMVs) using a 3-point scale. Concordance was calculated with Cohen’s κ. The numbers of MMVs in the basal ganglia were compared using Bland-Altman analysis and Wilcoxon’s signed-rank tests. MRA scan times were 4:07, 3:53, and 2:42 for PI3, CS3, and CS5, respectively. CS-reconstruction completed within 10 minutes. MMD grading and MMV visibility scales showed excellent correlation (κ > .966). Although the number of MMVs was significantly higher in CS3 than in PI3 (p < .0001) and CS5 (p < .0001), Bland-Altman analysis showed a good agreement between PI3, CS3, and CS5. Compressed sensing can accelerate TOF-MRA with improved visualization of small collaterals in equivalent time (CS3) or equivalent results in a shorter scan time (CS5).
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Affiliation(s)
- Takayuki Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohisa Okada
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Fujimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sachi Okuchi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hikaru Fukutomi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun C. Takahashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Funaki
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Yutaka Natsuaki
- Siemens Medical Solutions USA, Inc., Huntington Beach, California, United States of America
| | | | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Lanterna LA, Galliani S, Zangari R, Conti L, Brembilla C, Gritti P, Colleoni ML, Bernucci C. Thyroid Autoantibodies and the Clinical Presentation of Moyamoya Disease: A Prospective Study. J Stroke Cerebrovasc Dis 2018; 27:1194-1199. [PMID: 29305275 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/28/2017] [Accepted: 11/26/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Moyamoya is a rare cerebrovascular disease characterized by the progressive occlusion of the intracranial carotid artery. Thyroid autoantibodies have been found to be associated with the disease, but their clinical significance has never been studied. The objective of this study was to investigate the relationship between thyroid autoantibodies and the clinical presentation of moyamoya. METHODS This is a prospective study including 37 patients with moyamoya disease (MMD) or unilateral moyamoya (uMM). Thyroid function and thyroid autoantibodies (e.g., antithyroperoxidase and antithyroglobulin) were investigated. We studied the effect of gender, age, type of moyamoya (uMM versus MMD), and thyroid autoantibodies on the clinical presentation, dichotomized into aggressive (hemorrhage, major stroke, or frequent transient ischemic attack [TIA]) and nonaggressive presentation (headache, rare TIAs, and incidental diagnosis) according to the criteria of the Research Committee on Spontaneous Occlusion of the Circle of Willis. RESULTS Of the 37 patients included in the study, the autoantibodies were elevated in 9 (24.3%). An aggressive presentation occurred in 21 patients (hemorrhage in 11, major stroke in 9, frequent TIAs in 1). The autoantibodies were elevated in 8 of the 21 patients (38.09%) with an aggressive presentation and in 1 of those presenting with minor symptoms (6.2%). The presence of elevated autoantibodies was the only variable associated with an aggressive presentation in the multivariate logistic analysis (P = .048). CONCLUSIONS When the serum concentration of the thyroid autoantibodies is increased, the patients have a higher risk of an aggressive presentation. Our results support the hypothesis that activation of immune-mediated processes affects the moyamoya physiopathology.
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Affiliation(s)
- Luigi A Lanterna
- Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Silvia Galliani
- Department of Endocrinology and Metabolic disease, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rosalia Zangari
- Research Foundation Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luciano Conti
- Laboratory of Stem Cell Biology, Centre for Integrative Biology-CIBIO, University of Trento, Trento, Italy
| | - Carlo Brembilla
- Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Gritti
- Department of Neuroradiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Claudio Bernucci
- Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Abstract
RATIOINALE Relapsing polychondritis (RP) is a rare and heterogeneous disease complex of unknown origin which basically affects cartilaginous structures, 40% of which accompanied by rheumatic, hematologic, and endocrine disease. Among them, vasculitis is the most common accompanying type and usually presented with positive antineutrophilic cytoplasmic antibody (ANCA). The presence of ANCA could be primary or drug-induced like propylthiouracil (PTU). Central involvement of RP is very rare, and there is almost no report of cerebral vasculopathy manifested as moyamoya. PATIENT CONCERNS A 26-year-old woman complained about recurrent fever, auricular chondritis, ocular inflammation, and arthritis. She had an 8-year drug intake of PTU for Graves disease. Myeloperoxidase antineutrophilc cytoplasmic antibodies (MPO-ANCA) were found positive. Magnetic resonance angiography (MRA) detected multiple intracranial vasculopathy which we highly suspected it as moyamoya disease. DIAGNOSES Relapsing polychondritis, Graves disease and suspected moyamoya disease were clinically diagnosed. INTERVENTIONS AND OUTCOMES In case of possible PTU-induced vasculitis and the aggravation of vasculopathy, PTU was replaced by Iodine-131 (I) therapy. Induction treatment included oral prednisone 30 mg daily and oral cyclophosphamide 100 mg daily. Symptoms rapidly relieved before discharge. Inflammation markers were normal and MPO-ANCA decreased in 3 weeks after admission. Prednisone was gradually tapered to 7.5 mg daily and at month 10 azathioprine was continued for maintenance. LESSONS RP can overlap with Graves disease and moyamoya disease; comprehensive tests should be performed when admission. When relapsing polychondritis is accompanied with Graves disease, especially when ANCA is positive, PTU should be avoided.
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Laatar F, Kacem I, Nasri A, Ben Djebara M, Gargouri A, Gouider R. Generalized dystonia : unusual mode of revelation of Moyamoya disease. Tunis Med 2017; 95:504-505. [PMID: 29878297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Han JY, Choi JW, Wang KC, Phi JH, Lee JY, Chae JH, Park SH, Cheon JE, Kim SK. Coexistence of Radiation-Induced Meningioma and Moyamoya Syndrome 10 Years after Irradiation against Medulloblastoma: a Case Report. J Korean Med Sci 2017; 32:1896-1902. [PMID: 28960048 PMCID: PMC5639076 DOI: 10.3346/jkms.2017.32.11.1896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/03/2016] [Indexed: 11/20/2022] Open
Abstract
Radiotherapy is one of the standard treatments for medulloblastoma. However, therapeutic central nervous system irradiation in children may carry delayed side effects, such as radiation-induced tumor and vasculopathy. Here, we report the first case of coexisting meningioma and moyamoya syndrome, presenting 10 years after radiotherapy for medulloblastoma. A 13-year-old boy presented with an enhancing mass at the cerebral falx on magnetic resonance imaging (MRI) after surgery, radiotherapy (30.6 Gy craniospinal axis, 19.8 Gy posterior fossa) and chemotherapy against medulloblastoma 10 years ago, previously. The second tumor was meningioma. On postoperative day 5, he complained of right-sided motor weakness, motor dysphasia, dysarthria, and dysphagia. MRI revealed acute cerebral infarction in the left frontal lobe and both basal ganglia. MR and cerebral angiography confirmed underlying moyamoya syndrome. Four months after the meningioma surgery, the patient presented with headaches, dysarthria, and dizziness. Indirect bypass surgery was performed. He has been free from headaches since one month after the surgery. For patients who received radiotherapy for medulloblastoma at a young age, clinicians should consider the possibility of the coexistence of several complications. Careful follow up for development of secondary tumor and delayed vasculopathy is required.
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Affiliation(s)
- Ji Yeon Han
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Won Choi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Chang Wang
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Anatomy, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Hee Chae
- Division of Pediatric Neurology, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hye Park
- Department of Pathology, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Eun Cheon
- Division of Pediatric Radiology, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Zhao M, Zhang D, Wang S, Zhang Y, Wang R, Deng X, Gao F, Zhao J. Adolescents with moyamoya disease: clinical features, surgical treatment and long-term outcomes. Acta Neurochir (Wien) 2017; 159:2071-2080. [PMID: 28791519 DOI: 10.1007/s00701-017-3286-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/19/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to elucidate the clinical features, surgical treatment and long-term outcomes of adolescent patients with moyamoya disease. METHODS We reviewed consecutive patients with moyamoya vasculopathy who were admitted to our hospital from 2009 to 2015 to identify adolescent patients with moyamoya disease. Clinical features, surgical treatment and long-term outcomes were analyzed. Follow-up was performed by face-to-face or structured telephone interviews. Outcome measures were future stroke events. We performed univariate and multivariate time-to-event analyses to identify risk factors associated with future stroke events. RESULTS A total of 95 adolescent patients with moyamoya disease (age at onset, 13.1 ± 2.3 years) were included in this study. During follow-up, 12 patients (12.6%) had stroke events. We found that the patients who underwent direct/combined bypass had a significantly lower risk of future strokes [hazard ratio (HR), 0.16; 95% confidence interval (CI), 0.03-0.74; P = 0.019] compared to patients who underwent indirect bypass. CONCLUSIONS Our results demonstrate that direct/combined bypass can be more effective in preventing future strokes than indirect bypass in adolescent patients with moyamoya disease.
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Affiliation(s)
- Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Faliang Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050.
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
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Uchikawa H, Fujii K, Fujita M, Okunushi T, Shimojo N. Atypical moyamoya syndrome with brain calcification and stenosis of abdominal aorta and renal arteries. Brain Dev 2017; 39:710-713. [PMID: 28431773 DOI: 10.1016/j.braindev.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/27/2017] [Accepted: 04/03/2017] [Indexed: 01/31/2023]
Abstract
Moyamoya syndrome is a progressive cerebrovascular disease that is characterized by stenosis of the terminal portion of the internal carotid artery and its main branches, in combination with an accompanying disease. We herein describe an 8-year-old boy exhibiting transient loss of consciousness, who had recurrent seizures in infancy with progressive brain calcification. On admission, he was alert but magnetic resonance angiography showed bilateral stenosis of the whole internal carotid artery and proliferation of vascular collaterals, and brain CT revealed calcification on bilateral putamen. Given that this fulfilled diagnostic criteria, we finally diagnosed him as having moyamoya syndrome, though the etiology was unclear. Interestingly, a whole vessel survey revealed vascular stenosis of abdominal aorta and renal arteries, in which the former has not been reported in moyamoya syndrome. We considered that brain calcification was gradually formed by decreased cerebral vascular flow from infancy, and stenosis of abdominal aorta was possibly extended from renal arteries. This is, moyamoya syndrome with brain calcification and stenosis of abdominal aorta, suggesting that morphological screening of whole vessels containing cerebral and abdominal arteries should be considered in cases of slowly progressive brain calcification.
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Affiliation(s)
- Hideki Uchikawa
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Pediatrics, Eastern Chiba Medical Center, Togane, Japan.
| | - Katsunori Fujii
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mayuko Fujita
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoko Okunushi
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
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Hu W, Jiang W, Ye L, Tian Y, Shen B, Wang K. Prospective evaluation of the diagnostic value of plasma apelin 12 levels for differentiating patients with moyamoya and intracranial atherosclerotic diseases. Sci Rep 2017; 7:5452. [PMID: 28710384 PMCID: PMC5511181 DOI: 10.1038/s41598-017-05664-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/01/2017] [Indexed: 01/15/2023] Open
Abstract
Patients with moyamoya disease (MMD) or intracranial atherosclerotic disease (ICAD) experience similar cerebral ischaemic events. However, MMD patients show greater angiogenesis and arteriogenesis, which play crucial roles in collateral circulation development to enhance clinical prognosis and outcome. Apelins have been associated with angiogenesis and arteriogenesis. Therefore, the aim of the present study was to determine whether apelin levels were higher in patients with MMD than in patients with ICAD or in healthy controls. We compared plasma apelin levels in 29 patients with MMD, 82 patients with ICAD, and 25 healthy participants. Twelve-hour fasting blood samples were collected and analysed using commercially available kits. Univariate analyses indicated that compared with the ICAD and healthy control groups, the MMD group had higher apelin-12, apelin-13, apelin-36, and nitric oxide levels. Binary logistic regression analyses further showed that the plasma apelin-12 level was substantially higher in MMD patients than in ICAD patients. Patients with MMD were also differentiated from patients with ICAD by their mean ages, with the former being younger. Therefore, the plasma apelin-12 level is a potential diagnostic marker for differentiating MMD and ICAD and may provide a treatment strategy for enhancing collateral circulation development and clinical prognosis and outcome.
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Affiliation(s)
- Wei Hu
- Department of Neurology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Wan Jiang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Li Ye
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Bing Shen
- School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, 230032, China.
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China.
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Ullah S, Siddiqui AA, Alkilani WZ, Jang Khan NA, Siddiqui HU. Non-Atherosclerotic Obliteration Of Bilateral Supraclinoid Internal Carotid Arteries; A Classic Case Of Moyamoya Disease. J Ayub Med Coll Abbottabad 2017; 29:363-365. [PMID: 28718269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Moyamoya disease is an idiopathic progressive vasculopathy of distal internal carotid artery and circle of Willis which leads to the development of characteristic smoky appearance of the vascular collateral network on angiography. With the highest reported incidence among Japanese population, it has been under recognized as a cause of cerebrovascular accidents in Western countries. Here we report a case of a young 20-year-old Caucasian woman who presented to the emergency department with expressive aphasia, right arm weakness and numbness for three days. Imaging modalities confirmed Moyamoya disease.
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Affiliation(s)
- Saad Ullah
- Department of internal medicine, Conemaugh Memorial Medical Centre, Johnstown, PA, USA
| | | | - Waseem Zaid Alkilani
- Department of internal medicine, Conemaugh Memorial Medical Centre, Johnstown, PA, USA
| | - Noman Ahmed Jang Khan
- Department of internal medicine, Conemaugh Memorial Medical Centre, Johnstown, PA, USA
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Abstract
Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease characterized by progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Although its etiology is unknown, recent genetic studies have identified RNF213 in the 17q25-ter region as an important susceptibility gene of MMD among East Asian populations. A c.14576G>A polymorphism in RNF213 was identified in 95% of MMD patients with a family history and in 79% of sporadic cases, and patients carrying this polymorphism exhibited significantly earlier disease onset and a more-severe form of MMD. Due possibly to genetic differences, the prevalence of MMD is higher in East Asia (e.g., Korea and Japan) than in Western countries. The MMD prevalence peaks at two ages with different clinical presentations: around 10 years and at 30-45 years. Ischemic symptoms, including transient ischemic attacks, are the most important clinical manifestation in both children and adults. Intracranial hemorrhages are more frequent in adults than in children. Catheter angiography is a diagnostic method of choice. Magnetic resonance angiography and computed tomography angiography are noninvasive diagnostic methods. High-resolution vessel-wall magnetic resonance imaging also helps in diagnosing MMD by revealing concentric vessel-wall narrowing with basal collaterals. Surgical revascularization such as extracranial-intracranial bypass is the preferred procedure for MMD patients presenting with ischemic stroke. Surgical therapy may also be effective in patients with hemorrhages, based on recent observations in the Japan Adult Moyamoya trial. Procedure-related cerebral infarction and hyperperfusion syndrome are potential complications that can lead to neurological deterioration.
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Liu P, Lv XL, Liu AH, Chen C, Ge HJ, Jin HW, Feng X, Lv M, Li YX, Duan L. Intracranial Aneurysms Associated with Moyamoya Disease in Children: Clinical Features and Long-Term Surgical Outcome. World Neurosurg 2016; 94:513-520. [PMID: 27237414 DOI: 10.1016/j.wneu.2016.05.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/13/2016] [Accepted: 05/14/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Moyamoya disease (MMD) in children was rarely associated with intracranial aneurysms. The purpose of this study was to report the clinical characteristics and long-term surgical outcomes of pediatric intracranial aneurysms accompanied with MMD. METHODS Between October 2002 and October 2013, our department treated 9 pediatric MMD patients (aged ≤17 years) with intracranial aneurysms. Clinical and angiographic features, treatment selection, as well as follow-up information were obtained and analyzed. The efficacy of vascularization and the changes of intracranial aneurysms were evaluated with digital subtraction angiography (DSA). We also collected 7 previously published reports to analyze the characteristics of this rare condition. RESULTS In our series of 9 patients, 7 were male. The mean age was 11 ± 3.4 years (range 5-16). Seven patients presented with intracranial hemorrhage as the initial manifestation, while 2 patients suffered transient ischemic attacks. The most common aneurysm location was the posterior choroidal artery (4, 44.4%). One anterior choroidal artery aneurysm was completely embolized with Onyx (ev3, Irvine, California, USA). One posterior choroidal artery aneurysm failed due to inaccessibility to the parent artery. Bilateral encephalo-duro-arterio-synangiosis (EDAS) surgery was performed for all the children. During the follow-up period of 6.4 ± 2.2 years (range 3-11), spontaneous occlusion of aneurysm was observed in 4 children, including 1 child with middle cerebral artery aneurysm, 1 with lenticulostriate artery aneurysm, and 2 with posterior choroidal artery aneurysm. Good or fair vascularization was observed in all the 9 children with DSA follow-up. No patients suffered intracranial hemorrhage during the follow-up period. CONCLUSIONS The long-term survey showed EDAS surgery could effectively increase the cerebral blood flow and maintain good outcomes in children, which may further result in the disappearance of the intracranial aneurysms and decrease the incidence of recurrent hemorrhage.
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Affiliation(s)
- Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Department of Neurosurgery, 307 Hospital, PLA, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China
| | - Xian-Li Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China
| | - Ai-Hua Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China
| | - Cheng Chen
- Department of Neurosurgery, 307 Hospital, PLA, Beijing, PR China
| | - Hui-Jian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China
| | - Heng-Wei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China
| | - Xin Feng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China
| | - You-Xiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China.
| | - Lian Duan
- Department of Neurosurgery, 307 Hospital, PLA, Beijing, PR China.
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Kalani MYS, Spetzler RF, Wanebo JE. Keyhole Supraorbital Craniotomy for Aneurysm Clipping in the Setting of Bypass for Moyamoya Disease. World Neurosurg 2016; 94:442-446. [PMID: 27436206 DOI: 10.1016/j.wneu.2016.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND In 3%-15% of patients with moyamoya disease, aneurysms occur throughout the circle of Willis. In moyamoya patients treated with a superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass, treatment of a new or an enlarging aneurysm can be complicated by the presence of the bypass and by limitations on the use of standard frontotemporal craniotomies to gain access to the aneurysm. Furthermore, endovascular access can be limited by the presence of fragile moyamoya vessels and precluded by atresia of large vessels. CASE DESCRIPTION A 45-year-old female patient with a history of moyamoya disease and previous left STA-MCA bypass presented with an enlarging left superior cerebellar artery aneurysm. We used a keyhole supraorbital craniotomy as a minimally invasive route to treat this aneurysm of the circle of Willis, with minimal interruption to the existing bypass or collateral circulation. CONCLUSIONS In patients with moyamoya disease who have existing STA-MCA bypass and de novo or expanding aneurysms, treatment is fraught with challenges. We advocate the use of a minimally invasive keyhole supraorbital craniotomy with an eyebrow incision for aneurysms associated with moyamoya disease occurring on the proximal anterior cerebral and middle cerebral arteries, the anterior communicating artery, the basilar apex, the posterior communicating artery, the proximal superior cerebellar artery, and the posterior cerebral artery.
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Affiliation(s)
- M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - John E Wanebo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Kondziella D. [Diagnosis and treatment of rare causes of ischaemic stroke]. Ugeskr Laeger 2016; 178:V02160101. [PMID: 27402127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Rare causes of ischaemic stroke comprise a plethora of diagnoses of cardioembolic, inflammatory and genetic origin. The differential diagnosis is challenging but important because these disorders (e.g. monogenetic disorders such as COL4A1 mutations) often affect young individuals, they typically require sophisticated diagnostics (e.g. fluorescence angiography in Susac's syndrome) and they are increasingly treatable (e.g. enzyme replacement for Fabry's disease). This review discusses practical considerations and recent diagnostic and therapeutic advances in uncommon causes of ischaemic stroke.
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