Moyamoya‐disease‐related ischemic stroke in the postpartum period

Miyakoshi, Kei; Matsuoka, Misugi; Yasutomi, Daisuke; Tanaka, Mamoru; Yakubo, Kazumi; Fukuiya, Tatsuro; Yoshimura, Yasunori

doi:10.1111/j.1447-0756.2009.01031.x

Cited by 8 publications

(7 citation statements)

References 11 publications

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“…MRI and magnetic resonance angiography (MRA) revealed acute ischemic lesions in the right hemisphere along with steno-occlusive lesions of the ICA. 8 In a report by Ishimori et al, a 34-year-old Korean-American woman presented with tearfulness, social withdrawal, apathy, and mutism five days postpartum. The symptoms began three days after an uneventful spontaneous vaginal delivery notable only for an episode of hypertension.…”

Section: Discussionmentioning

confidence: 97%

A retrospective chart review of the perinatal period in 22 pregnancies of 16 women with Moyamoya disease

Fukushima

Yumoto

Kondo

et al. 2012

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 97%

A retrospective chart review of the perinatal period in 22 pregnancies of 16 women with Moyamoya disease

Fukushima

Yumoto

Kondo

et al. 2012

Journal of Clinical Neuroscience

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“…There is evidence that temporal cerebrovascular ischemia and visual disturbances are linked to a transient vasoconstriction of ICAs ( Arning et al, 1998 ). In the general population, moyamoya disease is characterized by carotid vasospasm that predisposes to ischemic stroke ( Miyakoshi et al, 2009 ). Therefore, maternal ischemic stroke may occur as a consequence of ICA occlusion due to arterial dissection or spontaneous constriction in Moyamoya disease ( Miyakoshi et al, 2009 ; Akamatsu et al, 2014 ; Simon et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

“…In the general population, moyamoya disease is characterized by carotid vasospasm that predisposes to ischemic stroke ( Miyakoshi et al, 2009 ). Therefore, maternal ischemic stroke may occur as a consequence of ICA occlusion due to arterial dissection or spontaneous constriction in Moyamoya disease ( Miyakoshi et al, 2009 ; Akamatsu et al, 2014 ; Simon et al, 2015 ). Taken together, these data suggests that some pregnancy-induced changes in the function and/or structure of internal carotid arteries may contribute to cerebral ischemia and/or stroke in very late gestation or during the PP period.…”

Section: Introductionmentioning

confidence: 99%

Deficiency in CD4 T Cells Leads to Enhanced Postpartum Internal Carotid Artery Vasoconstriction in Mice: The Role of Nitric Oxide

et al. 2021

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The risk of postpartum (PP) stroke is increased in complicated pregnancies. Deficiency in CD4 T cell subsets is associated with preeclampsia and may contribute to PP vascular disease, including internal carotid artery (ICA) stenosis and stroke. We hypothesized that CD4 T cell deficiency in pregnancy would result in ICA dysregulation, including enhanced ICA vasoconstriction. We characterized the function, mechanical behavior, and structure of ICAs from C57BL/6 (WT) and CD4 deficient (CD4KO) mice, and assessed the role of NO in the control of ICA function at pre-conception and PP. WT and CD4KO mice were housed under pathogen-free conditions, mated to same-strain males, and allowed to litter or left virgin. At 3 days or 4 weeks PP, mice were euthanized. The responses to phenylephrine (PE), high K+ and acetylcholine (ACh) were assessed in pressurized ICAs before and after NOS inhibition. Passive lumen diameters were measured at 3–140 mmHg. eNOS and iNOS expression as well as the presence of T cells were evaluated by immunohistochemistry. Constriction of WT ICAs to PE was not modified PP. In contrast, responses to PE were significantly increased in ICAs from PP as compared to virgin CD4KO mice. Constriction to high K+ was not enhanced PP. ICAs from WT and CD4KO mice were equally sensitive to ACh with a significant rightward shift of dose-response curves after L-NNA treatment. NOS inhibition enhanced PE constriction of ICAs from WT virgin and PP mice. Although a similar effect was detected in ICAs of virgin CD4KO mice, no such changes were observed in vessels from PP CD4KO mice. Passive arterial distensibility at physiological levels of pressure was not modified at PP. ICA diameters were significantly increased in PP with no change in vascular wall thickness. Comparison of eNOS expression in virgin, 3 days and 4 weeks PP revealed a reduced expression in ICA from CD4 KO vs. WT PP vessels which reached significance at 4 weeks PP. iNos expression was similar and decreased over the PP period in vessels from WT and CD4KO mice. Dysregulation of the CD4 T cell population in pregnancy may make ICA vulnerable to vasospasm due to decreased NO-dependent control of ICA constriction. This may lead to cerebral hypoperfusion and increase the risk of maternal PP stroke.

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“… 6 Provided that blood pressure and hypocapnia are well managed, pregnancy outcomes have been shown to be good, 7 , 8 although there are several reports of patients who experienced ischemic stroke postpartum even when delivery was carefully managed. 9 , 10 However, since only a few pregnant women are diagnosed with MMD, no standard obstetrical management protocol has been developed.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy Outcomes in Women with Moyamoya Disease: Experiences at a Single Center in Korea

et al. 2015

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This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Purpose: Moyamoya disease (MMD) occurs predominantly in Korean and Japanese women. The aim of this study was to investigate clinical features and pregnancy outcomes in women with MMD. Materials and Methods: We conducted a retrospective chart review of women with MMD who visited our Department of Obstetrics and Gynecology between January 2005 and October 2013. For all study subjects, clinical features, demographic characteristics, and perinatal outcomes were recorded. Results: We identified 28 pregnancies in 22 patients who had been diagnosed with MMD. The mean maternal age at delivery was 31.9±3.5 years old. The mean gestational age at delivery was 38.0±0.9 weeks. Among the 28 pregnancies, 25 (92.5%) underwent cesarean section; 19 (76.0%) of them were performed under regional anesthesia and six (24.0%) under general anesthesia. The mean newborn weight was 3233.7±348.2 g. The 5-minute Apgar score in 85% of the newborns was higher than 8, with no other apparent complications. During the puerperal period, transient ischemic attack symptom or seizure occurred in 4 cases, although patients recovered within a few days. Conclusion: For pregnant women with MMD, it is important to control blood pressure and prevent hyperventilation during the intrapartum period, and the best methods of delivery and anesthesia should be considered to avoid unfavorable sequelae. Additionally, a multidisciplinary approach (i.e., neurosurgery) is necessary to constantly manage underlying diseases.

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Moyamoya‐disease‐related ischemic stroke in the postpartum period

Cited by 8 publications

References 11 publications

A retrospective chart review of the perinatal period in 22 pregnancies of 16 women with Moyamoya disease

A retrospective chart review of the perinatal period in 22 pregnancies of 16 women with Moyamoya disease

Deficiency in CD4 T Cells Leads to Enhanced Postpartum Internal Carotid Artery Vasoconstriction in Mice: The Role of Nitric Oxide

Pregnancy Outcomes in Women with Moyamoya Disease: Experiences at a Single Center in Korea

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