Prognosis of occlusive disease of the circle of Willis (moyamoya disease) in children

Kurokawa, Toru; Tomita, Shigeru; Ueda, Kohji; Narazaki, Osamu; Hanai, Toshio; Kanehiro, Hiromichi; Matsushima, Toshio; Kitamura, Katsutoshi

doi:10.1016/0887-8994(85)90027-x

Cited by 143 publications

(71 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3 In another study of pediatric MMD, 79% of the patients suffered from recurrent ischemia with intellectual impairment, and the mortality rate was 3.7% (1 of 27 patients died). 24 In the present study of adult MMD, the annual risk of ischemia was 2.2% in all patients and 3.0% in patients with ischemic presentation. In addition, the 5-and 10-year cumulative risks of ischemic events were 9% and 20%, respectively, in all patients, and 13% and 28% in patients with ischemic presentation.…”

Section: Discussionmentioning

confidence: 90%

“…21,24,30,40 According to one report, 21 mortality rates were 7% after initial bleeding and 29% after rebleeding. In this study, the incidences of stroke during follow-up were similar among the clinical groups of hemorrhagic, ischemic, and asymptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,9,16,19,36 Although the pathogenesis and natural course are not yet known, revascularization surgery has been satisfactory for patients with ischemic symptoms. 2,3,5,7,8,18,22,24,34 For pediatric MMD, revascularization surgery is universally recommended, regardless of the severity of MMD, because most symptoms are ischemic, and children's brains are still developing. 18,19,27,34,37 In adult-onset MMD, revascularization surgery is selectively recommended for patients with ischemic symptoms and hemodynamic compromise.…”

mentioning

confidence: 99%

See 2 more Smart Citations

The natural clinical course of hemodynamically stable adult moyamoya disease

Cho¹,

Chung²,

Kim³

et al. 2015

JNS

View full text Add to dashboard Cite

OBJect Moyamoya disease (MMD) is a rare cerebrovascular disease and its natural history is still unclear. The authors aimed to investigate the natural course of hemodynamically stable cases of adult MMD, with the analysis of stroke risk factors. MetHODS Two hundred forty-one patients were included in this retrospective study. One hundred sixty-six (68.9%) were female, and mean age (± SD) at first visit was 41.3 ± 12.0 years (range 18-69 years). Unilateral involvement was identified in 33 patients, and 19 patients (7.9%) had a family history of MMD. According to the clinical presentations, patients were classified into hemorrhagic (n = 62, 25.7%), ischemic (n = 144, 59.8%), and asymptomatic (n = 35, 14.5%) groups. The mean duration of follow-up was 82.5 ± 62.9 months (range 7.3-347.0 months). reSultS The annual stroke risk was 4.5%, and the annual risks of rebleeding in the hemorrhagic group and recurrent ischemic events in the ischemic group were 4.3% and 3.0%, respectively. There was no significant difference in cumulative stroke risk between the 3 groups (p = 0.461). Risk factors included thyroid disease for overall strokes (HR 2.56, 95% CI 1.16-5.67), initial hemorrhagic presentation for hemorrhagic strokes (HR 2.53, 95% CI 1.24-5.17), and initial ischemic presentation for ischemic strokes (HR 2.69, 95% CI 1.15-6.27). Familial MMD was a common risk factor for all types of stroke. Among the 3 clinical groups, the hemorrhagic group showed the worst clinical status at discharge and at most recent follow-up. Twenty-three patients (9.5%) eventually underwent revascularization surgery. cOncluSiOnS There was no statistically significant difference in the incidence of stroke in the different clinical groups; clinical status, however, was most severe in patients with hemorrhagic presentation. In patients who experienced stroke during the follow-up period, the stroke type tended to correspond to their initial presentation. Close follow-up is needed in patients with thyroid disease and a family history of MMD.http://thejns.org/doi/abs/10.3171/2014.9.JNS132281 KEY WORDS asymptomatic; hemorrhage; ischemia; moyamoya disease; clinical course; vascular disorders aBBreViatiOnS KPS = Karnofsky Performance Scale; MMD = moyamoya disease; mRS = modified Rankin Scale; SAH = subarachnoid hemorrhage; SPECT = single photon emission computed tomography; TIA = transient ischemic attack.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

The natural clinical course of hemodynamically stable adult moyamoya disease

Cho¹,

Chung²,

Kim³

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…3) Other studies have suggested that intellectual impairment would progress, even in TIA-type patients, if they did not undergo appropriate surgical treatment. 16,19) We are not certain whether direct STA-ACA bypass is always necessary or only indirect bypass targeting the medial frontal area such as EGAS is sufficient for this intellectual improvement. Further follow-up studies are necessary.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Superficial Temporal Artery to Middle Cerebral or Anterior Cerebral Artery Bypass With Pan-synangiosis for Moyamoya Disease Covering Both Anterior and Middle Cerebral Artery Territories-Technical Note-

Ishikawa

Kamiyama

Kuroda

et al. 2006

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Some patients with moyamoya disease treated by conventional surgical procedures may develop postoperative refractory ischemia and perioperative cerebral infarction in the anterior cerebral artery (ACA) territory. We present a novel operative procedure for moyamoya disease to avoid the risk of ischemia in the ACA territory, which consists of simultaneous superficial temporal artery (STA) to middle cerebral artery (MCA) or ACA bypass with pan-synangiosis, encephalo-duro-arterio-myosynangiosis for the lateral frontal and temporal areas, and encephalo-galeo-arterio-synangiosis for the medial frontal area. This procedure can establish direct bypass to the ACA territory at the first intervention. Simultaneous STA-MCA and STA-ACA bypasses with pan-synangiosis is suitable for patients with moyamoya disease associated with severely impaired perfusion of the ACA territory requiring direct bypass surgery.

show abstract

“…Based on these observations, follow-up MR examination should be planned with shorter interval, for example, every 3 to 6 months. In addition, it is well known that functional and/or intellectual outcomes are poor in pediatric patients presenting with ischemic stroke due to moyamoya disease [13][14][15]. To prevent the occurrence of cerebral infarction, therefore, regular imaging studies should also be planned with shorter intervals in the conservatively treated children with moyamoya disease, because MRI and MRA studies enable it to accurately detect disease progression at outpatient clinic [16].…”

Section: Discussionmentioning

confidence: 99%

Headache attack followed by rapid disease progression in pediatric moyamoya disease—how should we manage it?

et al. 2014

View full text Add to dashboard Cite

Case report A 4-year-old female was presented at our hospital with frequent right frontal headache attack. She was diagnosed with moyamoya disease and was conservatively followed up. One year later, the frequency of headache gradually decreased. However, follow-up MR imaging revealed that the disease stage markedly progressed in the right side and cerebral infarction occurred in the temporal lobe with atrophy of the right frontal lobe. She underwent direct and indirect revascularization on the right side. Conclusion Aware of this case, we would like to emphasize that headache may be one subtype of ischemic attacks and require frequent MR follow-up to see the disease course. If there is any sign of disease progression, immediate surgical intervention should be indicated to avoid irreversible brain damage.

show abstract

Prognosis of occlusive disease of the circle of Willis (moyamoya disease) in children

Cited by 143 publications

References 20 publications

The natural clinical course of hemodynamically stable adult moyamoya disease

The natural clinical course of hemodynamically stable adult moyamoya disease

Simultaneous Superficial Temporal Artery to Middle Cerebral or Anterior Cerebral Artery Bypass With Pan-synangiosis for Moyamoya Disease Covering Both Anterior and Middle Cerebral Artery Territories-Technical Note-

Headache attack followed by rapid disease progression in pediatric moyamoya disease—how should we manage it?

Contact Info

Product

Resources

About