Pediatric moyamoya disease presenting with intracerebral hemorrhage—Report of three cases and review of the literature

Suyama, Kazuhiko; Yoshida, Koichi; Takahata, Hideaki; Toda, Keisuke; Baba, Hiroshi; Ishikawa, Yasunari; Hirose, Masao; Nagata, Izumi

doi:10.1016/j.clineuro.2007.10.006

Cited by 17 publications

(11 citation statements)

References 30 publications

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“…1,4,8,9,[11][12][13] Infarction occurred in these patients mainly during the subacute stage between postictal days 7 and 16, with the exception of two patients in whom infarction and intracranial bleed- ing occurred simultaneously. 1,8) Increased ICP, dehydration, vasospasm, and shrinkage of the ruptured vessels have been proposed as the components of the pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

Acute Cerebral Ischemia After Intracranial Bleeding in Unilateral Moyamoya Disease

Shibamoto¹,

Aoyama²,

Taki³

et al. 2012

Neurol. Med. Chir.(Tokyo)

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A 31-year-old male presenting with intracranial hemorrhage manifesting as deep coma and anisocoria underwent immediate emergency surgery. Three-dimensional computed tomography (CT) angiography revealed stenosis of the right middle cerebral artery (MCA) and perfusion CT immediately after the surgery suggested severe hypoperfusion in the right MCA territory. Postoperative angiography demonstrated right unilateral moyamoya disease. We predicted that brain edema and intracranial pressure (ICP) elevation occurring after the hemorrhage might result in cerebral infarction. Hyperosmotic drugs were contraindicated by dehydration. Therefore, therapeutic hypothermia was induced that controlled the ICP. We considered that the increased ICP, dehydration, vasospasm, and shrinkage of the ruptured vessel comprised the pathogenesis of acute cerebral ischemia after intracranial bleeding. Cerebral hemodynamics should be evaluated during the acute phase of cerebral hemorrhage to prevent subsequent cerebral infarction.

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Section: Discussionmentioning

confidence: 99%

Acute Cerebral Ischemia After Intracranial Bleeding in Unilateral Moyamoya Disease

Shibamoto¹,

Aoyama²,

Taki³

et al. 2012

Neurol. Med. Chir.(Tokyo)

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“…[1] ICH is common in adult patients with Moyamoya disease, but it is an infrequent entity in the pediatric age group. [3] The risk of ischemic complications in patients with bleeding-type Moyamoya disease is poorly understood with a few cases reported, mainly in adults. [4] But we are presenting a case of post-ICH cerebral infarction which is a rare entity in children with Moyamoya disease.…”

Section: Introductionmentioning

confidence: 99%

Cerebral infarction following intracranial hemorrhage in pediatric Moyamoya disease - A case report and brief review of literature

Patra

Purkait

Sinhamahapatra

et al. 2012

Ann Indian Acad Neurol

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Moyamoya disease is a clinical entity characterized by progressive cerebrovascular occlusion with spontaneous development of a collateral vascular network called Moyamoya vessels. This disease mainly manifests as cerebral ischemia. Intracranial bleeding is another major presentation of patients with Moyamoya disease. We report here a 12-year-old male child who presented with severe headache, vomiting and meningismus. Initial neuroimaging study with noncontrast computed tomography scan revealed fresh intraventricular hemorrhage in right-sided lateral ventricle. Magnetic resonance imaging with angiography of brain was done 5 days later when the child developed right-sided hemiparesis, and the diagnosis of Moyamoya disease was confirmed along with lacunar infarction of right posterior peri and paraventricular area and in the left paraventricular area and centrum semiovale. Simultaneous presence of cerebral infarction along with intraventricular hemorrhage in adult with bleeding-type Moyamoya disease is reported in literature, but it is a rare entity in a child.

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“…The incidence of hemorrhagic and ischemic stroke was significantly lower in patients who underwent STA-MCA bypass when compared with patients who underwent encephaloduroarteriosynangiosis or conservative therapy. 28 In the pediatric population, there may be also a benefit of revascularization; Suyama et al 58 reported on 3 patients with hemorrhagic MMD, 2 of whom underwent STA-MCA anastomoses with encephalomyosynangiosis. No subsequent evidence of ischemic episodes or hemorrhage was noted at follow-up in these 2 patients.…”

Section: Treatmentmentioning

confidence: 99%

Moyamoya disease: a summary

Burke

Burke²,

Sherma

et al. 2009

FOC

173

150

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Moyamoya, meaning a “hazy puff of smoke” in Japanese, is a chronic, occlusive cerebrovascular disease involving bilateral stenosis or occlusion of the terminal portion of the internal carotid arteries (ICAs) and/or the proximal portions of the anterior cerebral arteries and middle cerebral arteries (MCAs). The Ministry of Health and Welfare of Japan has defined 4 types of moyamoya disease (MMD): ischemic, hemorrhagic, epileptic, and “other.” The ischemic type has been shown to predominate in childhood, while the hemorrhagic type is more often observed in the adult population. The highest prevalence of MMD is found in Japan, with a higher female to male ratio. Studies have shown a possible genetic association of MMD linked to chromosome 17 in Japanese cases as well as in cases found in other demographics. During autopsy, intracerebral hematoma is found and most commonly serves as the major cause of death in patients with MMD. Moyamoya vessels at the base of the brain are composed of medium-sized or small muscular arteries emanating from the circle of Willis, mainly the intracranial portions of ICAs, anterior choroidal arteries, and posterior cerebral arteries, forming complex channels that connect with distal positions of the MCAs. Off of these channels are small tortuous and dilated vessels that penetrate into the base of the brain at the site of the thalamoperforate and lenticulostriate arteries. On angiography, there is the characteristic stenosis or occlusion bilaterally at the terminal portion of the ICAs as well as the moyamoya vessels at the base of the brain. Six angiographic stages have been described, from Stage 1, which reveals a narrowing of the carotid forks, to Stage 6, in which the moyamoya vessels disappear and collateral circulation is produced solely from the external carotid arteries. Cases with milder symptoms are usually treated conservatively; however, more severe symptomatic cases are treated using revascularization procedures. Surgical treatments are divided into 3 types: direct, indirect, and combined/other methods. Direct bypass includes superficial temporal artery-MCA bypass or use of other graft types. Indirect procedures bring in circulation to the intracranial regions by introducing newly developed vasculature from newly approximated tissues. These procedures may not be enough to prevent further ischemia; therefore, a combination of direct and indirect procedures is more suitable. This article will give a review of the epidemiology, natural history, pathology, pathophysiology, and diagnostic criteria, including imaging, and briefly describe the surgical treatment of MMD.

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Pediatric moyamoya disease presenting with intracerebral hemorrhage—Report of three cases and review of the literature

Cited by 17 publications

References 30 publications

Acute Cerebral Ischemia After Intracranial Bleeding in Unilateral Moyamoya Disease

Acute Cerebral Ischemia After Intracranial Bleeding in Unilateral Moyamoya Disease

Cerebral infarction following intracranial hemorrhage in pediatric Moyamoya disease - A case report and brief review of literature

Moyamoya disease: a summary

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