Prevalence of and Risk Factors for Cerebral Microbleeds in Moyamoya Disease and Syndrome in the American Population

Abstract

Background and Purpose: Cerebral microbleeds (CMB) are reported to be frequent in moyamoya disease (MMD) and moyamoya syndrome (MMS) in the Asian population. It is associated with an increased risk of intracerebral hemorrhage. The significance of CMB in MMD/MMS in non-Asian populations has not been well established. Our study aimed to investigate the prevalence of CMB in MMD/MMS in a moymoya cohort with a majority of non-Asians and to identify risk factors for developing a CMB and its predictive value for subsequent vascular events. Methods: The moyamoya database was compiled by screening for MMD/MMS among patients admitted to the Zale-Lipshy University Hospital at the University of Texas Southwestern Medical Center. We identified and analyzed data of 67 patients with MMD or MMS. Patients were characterized as CMB+ or CMB– based on MRI findings. In CMB+ patients, the total number and location of CMB were identified. Univariate and multivariate logistic regression were used to identify risk factors for developing CMB and whether CMB are associated with the development of subsequent vascular events. Results: Out of a total of 67 patients, 11 (16%) had CMB. Males had significantly higher odds of having CMB as compared to females (OR 1.76; 95% CI 1.40–24.3, p = 0.021). The incidence of CMB was also associated with age at diagnosis (mean age of CMB+ patients vs. CMB– patients: 44 vs. 34 years, respectively, p = 0.024), smoking (p = 0.006), and hemorrhagic stroke at presentation (p = 0.034). Logistic regression with multivariate analysis found that gender and age at diagnosis remained statistically significant. New ischemic events occurred in 2 (20%) out of 10 CMB+ patients and 13 (23%) out of 55 CMB– patients, respectively (p = 0.79). While 2 (3%) CMB– patients had a new cerebral hemorrhage during follow-up, none of the CMB+ patients did. Conclusions: CMB are less prevalent in MMD/MMS in the USA than in Asia. An older age at diagnosis and male gender were associated with CMB. The presence of CMB was not associated with an increased risk of a subsequent ischemic or hemorrhagic stroke.

Surgical revascularization vs. conservative treatment for adult hemorrhagic moyamoya disease: analysis of rebleeding in 322 consecutive patients

“…HMD is a common type of cerebrovascular disease with high rates of disability, mortality, and high risk of rebleeding [30]. In our cohort, patients with HMD were more frequent than those with ischemic type, accounting for 55.8% of all MMD patients, higher than reports from North America and Europe [10,14]. It primarily affected adult females, with a female to male ratio of 1.385:1.0.…”

“…In fact, the pathogenesis of recurrent hemorrhage in HMD remains unclear. The fragile collateral vessels, concomitant microaneurysms, abnormal dilation and branch extension of AChA-PCoA, and cerebral microbleeds may be responsible [10,12,19,26]. In this study, 47 patients (14.6%) had intracranial aneurysms, nearly half of them suffered from rebleeding.…”

“…Cerebral ischemia and transient ischemic attack are common in North American and European patients. In contrast, Asian patients are more likely to suffer intracranial hemorrhage as the initial symptom [10,14]. In fact, rebleeding is the leading cause of death in hemorrhagic moyamoya disease (HMD), the frequency of rebleeding ranges between 16 and 66%, and Shaojie Yu and Nan Zhang contributed equally to this article.…”

Predictors of Stroke Outcomes in Conservatively Treated Patients With Moyamoya Disease: A Follow‐up MRI Study

“…Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive stenosis or occlusion of the distal intracranial internal carotid artery (ICA) and proximal middle and anterior cerebral artery, with the development of a collateral network at the base of the brain 1,2 . Intracranial ischemia and hemorrhage are the two main manifestations associated with this disease, and indicate a poor prognosis and an increased risk of mortality 3–5 . Thus, the early risk stratification of MMD patients with high‐risk of intracranial stroke could help guide clinical treatment and potentially reduce adverse outcomes.…”

“…associated with this disease, and indicate a poor prognosis and an increased risk of mortality. [3][4][5] Thus, the early risk stratification of MMD patients with high-risk of intracranial stroke could help guide clinical treatment and potentially reduce adverse outcomes.…”