Moyamoya disease (MMD) is characterized by progressive occlusion of the internal carotid artery or its terminal branches, associated with formation of extensive collateral vessels (moyamoya vessels) at the base of the brain. Whether unilateral moyamoya disease, confirmed by typical angiographic evidence of moyamoya disease unilaterally and normal or equivocal findings contralaterally, is an early form of definite (bilateral) moyamoya disease remains
Objective: We report a case of acute cerebral ischemia with tandem lesion in a patient who underwent emergent carotid artery stenting (CAS) and intracranial thrombectomy. Case presentation: A 59-year-old female suffering from aphasia and right hemiparesis was taken in ambulance, 78 minutes later from acute onset. National Institute of Health Stroke Scale was 25. Diffusion-weighted image (DWI) MRI showed acute infarction at left insula cortex, basal ganglia and frontal lobe, and MRA showed left internal carotid artery (ICA) occlusion. Clinical-DWI mismatch was admitted, we performed interventional therapy. DSA showed not only left intracranial ICA occlusion but also left cervical ICA severe stenosis. We placed carotid wallstent at cervical ICA stenosis site. After CAS, we performed thrombectomy for intracranial ICA, and gained complete recanalization. Postinterventional course was uneventful. Right hemiparesis was dramatically improved but motor aphasia was remained at discharge. Conclusion: We reported a case of acute cerebral infarction with tandem lesion leading to improving neurological deficits by CAS and thrombectomy. Interventional therapy for tandem lesion was useful.
Author (year) Case Age /Sex Side Clinical presentation Angiographic finding of M1 Aneurysm Cerebral blood flow Treatment Intraoperative or pathological findings Outcome (hemorrhage) (M1-lesion)
Summary:A stroke care unit (SCU) was established in Nagasaki University Hospital in June 2008, and comprehensive stroke care, together with a neurologist, neurosurgeon, dentist, physiotherapist, nurse and case worker, started. Totally, 236 patients, 143 males and 93 females aged from 1 to 97 years old (mean 63.3 years), were treated in SCU over a period of 12 months. The diagnostic category treated in SCU was cerebral infarction in 89 patients, cerebral hemorrhage in 71 patients and subarachnoid hemorrhage in 31 patients. In addition to stroke patients, patients with epilepsy or head injury and patients requiring neurological surgery were also treated in SCU. Advanced acute rehabilitation was applied to 160 patients. Dysphasia was evaluated by the dentist, and 87 patients were received dysphasia management. The hospital stay was shortened from 28 days to 22. An SCU is useful for the treatment of stroke patients as well as neurosurgical patients.
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