Moyamoya

Yilmaz, Engin Y.; Pritz, Michael B.; Bruno, Askiel; Lopez-Yunez, Alfredo M.; Biller, José

doi:10.1001/archneur.58.8.1274

Cited by 93 publications

(35 citation statements)

References 20 publications

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“…The presence of another medical condition previously identified as a risk factor for recurrence 14 is related to the risk of radiological recurrence. Although there may be a spectrum of severity for moyamoya, 15,16 from these and other data, 17,18 the risk of recurrence is significantly higher in this group. Investigation of the cerebral circulation appears to be justified in all children presenting with stroke and should probably be undertaken in the acute phase so that sinovenous thrombosis, which may be associated with cortical infarction in the frontal, parietal, and occipital lobes mimicking an arterial distribution, 19 is excluded.…”

Section: Discussionsupporting

confidence: 44%

Clinical and Radiological Recurrence After Childhood Arterial Ischemic Stroke

et al. 2006

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Background-Data on rates and risk factors for clinical and radiological recurrence of childhood arterial ischemic stroke (AIS) might inform secondary prevention strategies. Methods and Results-Consecutive Great Ormond Street Hospital patients with first AIS were identified retrospectively (1978 -1990) and prospectively (1990 -2000). Patients underwent repeat neuroimaging at the time of clinical recurrence or, if asymptomatic, at least 1 year after AIS. Cox and logistic regression analyses were used to explore the relationships between risk factors and clinical and radiological recurrence, respectively. A total of 212 patients were identified, of whom 97 had another prior diagnosis. Seventy-nine children had a clinical recurrence (29 strokes, 46 transient ischemic attacks [TIAs], 4 deaths with reinfarction 1 day to 11.5 years (median 267 days) later); after 5 years, 59% (95% confidence interval, 51% to 67%) were recurrence free. Moyamoya on angiography and low birth weight were independently associated with clinical recurrence in the whole group. Genetic thrombophilia was associated with clinical recurrence in previously healthy patients, independent of the presence of moyamoya. Sixty of 179 patients who had repeat neuroimaging had radiological reinfarction, which was clinically silent in 20. Previous TIA, bilateral infarction, prior diagnosis (specifically immunodeficiency), and leukocytosis were independently associated with reinfarction. Previous TIA and leukocytosis were also independently associated with clinically silent reinfarction. Conclusions-Clinical and radiological recurrence are common after childhood AIS. The risk of clinical recurrence is increased in children with moyamoya and, in previously healthy patients, in those with genetic thrombophilia. Preexisting pathology, including immunodeficiency, and persistent leukocytosis are risk factors for radiological recurrence, which suggests a potential role for chronic infection.

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Section: Discussionsupporting

confidence: 44%

Clinical and Radiological Recurrence After Childhood Arterial Ischemic Stroke

et al. 2006

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“…Children appear to be more likely to present with ischemic events (either strokes or TIAs) and adults with hemorrhage, leading to more rapid diagnosis. 119,120 The significance of ischemic events in children usually proves more difficult to diagnose because of the patient's age and limited communication skills, leading to delayed recognition of the underlying moyamoya condition. 3 Associated Conditions.…”

Section: Moyamoya Disease and Moyamoya Syndromementioning

confidence: 99%

Management of Stroke in Infants and Children

Roach¹,

Golomb²,

Adams³

et al. 2008

Stroke

872

377

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Purpose— The purpose of this statement is to review the literature on childhood stroke and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians who are responsible for diagnosing and treating infants, children, and adolescents with cerebrovascular disease. Methods— The Writing Group members were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee. The panel included members with several different areas of expertise. Each of the panel’s recommendations was weighted by applying the American Heart Association Stroke Council’s Levels of Evidence grading algorithm. After being reviewed by panel members, the manuscript was reviewed by 4 expert peer reviewers and by members of the Stroke Council Leadership Committee and was approved by the American Heart Association Science Advisory and Coordinating Committee. We anticipate that this statement will need to be updated in 4 years. Results— Evidence-based recommendations are provided for the prevention of ischemic stroke caused by sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Recommendations on the evaluation and management of hemorrhagic stroke also are provided. Protocols for dosing of heparin and warfarin in children are suggested. Also included are recommendations on the evaluation and management of perinatal stroke and cerebral sinovenous thrombosis in children.

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“…Higher rates of hemorrhagic Moyamoya disease in adults are witnessed in Japan and Korea, 51 and 69%, respectively [19]. The lower incidence of hemorrhagic Moyamoya disease in adults is also seen in other US studies [6,8,20]. The underlying pathophysiology of Moyamoya disease in the USA may have distinct features that account for the lower hemorrhagic rate in adults.…”

Section: Discussionmentioning

confidence: 87%

Epidemiological and Clinical Features of Moyamoya Disease in the USA

et al. 2013

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Background: An increasing number of cases of Moyamoya disease have been reported in the Japanese and US literature. We performed this study to quantify the rise in the prevalence of Moyamoya disease and to study the unique epidemiological and clinical features in the USA that may explain a change in incidence. Methods: We analyzed data derived from patients entered in the Nationwide Inpatient Sample between 2005 and 2008, using ICD-9 codes for Moyamoya disease. Data including patient age, gender, ethnicity, secondary diagnosis, medical complications, and hospital costs were obtained. Results: From 2005 to 2008 in the USA, there were an estimated 7,473 patients admitted with a primary or secondary diagnosis of Moyamoya disease. Patients admitted with Moyamoya disease were most frequently women and Caucasian. Overall, ischemic stroke was the most common reason for admission. Hemorrhagic stroke was more frequent in adults compared with children, 18.1 versus 1.5% (p < 0.05). Conclusion: The number of patients identified and admitted with Moyamoya disease has risen dramatically in the last decade. This study can lead to a better understanding of the disease pattern and healthcare consequences in the USA and suggests that pathophysiologic differences in Moyamoya disease may exist.

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Moyamoya

Cited by 93 publications

References 20 publications

Clinical and Radiological Recurrence After Childhood Arterial Ischemic Stroke

Clinical and Radiological Recurrence After Childhood Arterial Ischemic Stroke

Management of Stroke in Infants and Children

Epidemiological and Clinical Features of Moyamoya Disease in the USA

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