Progression of arteriovenous malformation in moyamoya syndrome

Abstract

We report a case of moyamoya disease (MMD) associated with arteriovenous malformation (AVM). The 30-year-old female patient presented with left-hemispheric transient ischaemic attacks (TIAs) involving dysphasia and right-sided hemiparesis. CT-scan and lumbar puncture showed no evidence of intracranial haemorrhage. Cerebral angiography revealed typical moyamoya vessels and occlusion of multiple cerebral arteries with consecutive collateral blood supply. Moreover, a left-parietal AVM with a diameter of approximately 2 cm was detected. An extra-intracranial arterial bypass (EIAB) connecting the left superficial temporal artery (STA) with a cortical branch of the left middle cerebral artery (MCA) was performed (STA-MCA anastomosis) and yielded subsequent resolution of the neurological deficit. Nine months post-operatively neurological deficits similar to those of the initial presentation recurred. Repeated angiography suggested comparatively increased AVM blood flow, and successful extirpation of the AVM gradually re-established almost full functional ability. However, deterioration of the neurological condition developed again. We herewith present the first European case of moyamoya disease associated with arteriovenous malformation and report the clinical course under an alternative neurosurgical treatment consisting of STA-MCA anastomosis and delayed extirpation of the AVM.

Development of a de novo cerebral arteriovenous malformation in a child with sickle cell disease and moyamoya arteriopathy

“…5,14,18,43 Despite the absence of a previously published description of cerebral AVM in a patient with SCD, numerous AVMs have been documented in patients with moyamoya disease. 1,13,16,17,20,22,33,[42][43][44] Although the exact relationship between moyamoya disease and formation of AVMs has not yet been defined, several researchers have suggested that increased angiogenic factors found in the cerebrospinal fluid of patients with moymoya disease may play an important role. 24,42,43 Alternatively, Mawad, et al, 26 have argued that the vascular changes in moyamoya disease may be induced by AVMs.…”

Progression of Stenosis Into Occlusion of the Distal Posterior Cerebral Artery Supplying an Occipital Arteriovenous Malformation Manifesting as Multiple Ischemic Attacks

“…Although occlusion of the main trunk of feeding arteries of the AVM was reported in 1.4% of cases, 2) we identified only seven previous cases of feeding artery occlusion with symptoms related to ischemia (Table 1). 2,3,6,7,11) Usually, the mechanism of occlusion in most previous cases seemed to be a chronic process. All these seven previous cases had moyamoya vessels or pial collateral flow from the other main trunk arteries, but whether the pathological process was a comorbid condi- …”

Moyamoya Syndrome Associated With Gamma Knife Surgery for Cerebral Arteriovenous Malformation

“…Most cases had both neurovascular anomalies at the first presentation. 1,3,6,10,11,13,16) High CBF related to the AVM may cause hemodynamic stress and affect the endothelium of the circle of Willis. 10,11) Some cases of moyamoya disease show de novo development of AVM in the followup periods.…”