Moyamoya Disease

2019 ◽  
pp. 149-156
Author(s):  
Edward Smith
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Arteries ◽  
Pressure Control ◽  
Vascular Supply ◽  
External Carotid Artery ◽  
External Carotid ◽  
Middle Cerebral Arteries ◽  
Detailed Assessment ◽  
Collateral Vessels ◽  
Carotid Circulation

Moyamoya disease is defined by stenosis of the distal intracranial internal carotid arteries up to and including the bifurcation, with segments of the proximal anterior and middle cerebral arteries, dilated basal collateral vessels, and bilateral findings. Detailed assessment with digital subtraction angiography will define the severity of disease (Suzuki stage) and presence of spontaneous transdural collateral vessels from external carotid artery branches. These collateral vessels must be protected during surgical intervention. The surgical goal is to establish a new vascular supply to the areas of the brain at risk for stroke, utilizing vessels from the external carotid circulation. Blood pressure control and avoidance of hyperventilation are key to minimize perioperative stroke risk. Preoperative hydration, ongoing use of aspirin, and good pain control will also minimize surgical complications.

scholarly journals A case of Young Stroke due to Moyamoya Disease

2020 ◽  
Vol 15 (1) ◽  
pp. 110-113
Author(s):  
Md Abdur Razzak ◽  
Ghulam Kawnayn ◽  
Fateha Naznin ◽  
Quazi Audry Arafat Rahman
Keyword(s):  
Moyamoya Disease ◽  
Past History ◽  
Cerebral Arteries ◽  
Armed Forces ◽  
Cerebral Angiogram ◽  
Medical College ◽  
Middle Cerebral Arteries ◽  
History Of ◽  
Collateral Vessels ◽  
The Right

Moyamoya disease is a disease in which certain arteries in the brain are constricted. Blood flow is blocked by the constriction, and also by blood clots (thrombosis). A collateral circulation develops around the blocked vessels to compensate for the blockage, but the collateral vessels are small, weak, and prone to bleeding, aneurysm and thrombosis which may result in TIA, recurrent ischemic or hemorrhagic stroke or seizure. The disease may manifest in pediatric age or young adults. In May 2019 we have diagnosed a young lady with Moyamoya disease who presented with right sided hemiplegia, motor aphasia and dysphagia. She was labeled as hypertensive 6 months prior to this event and used to take anti-hypertensive irregularly and gave past history of occasional headache. Her CT scan and MRI of brain revealed left sided ischemic infarct involving frontotemporoparietal region and cerebral angiogram revealed narrowing of left MCA and non-visualization of distal part. There is extensive fine collaterals (Moyamoya vessels) giving the appearance of puffed smoke. The right ACA and MCA were also narrowed with appearance of early collateral vessels. She was treated with aspirin, PPI, NG feeding, antihypertensive medication, physiotherapy, rehabilitation therapy and other supportive care. His condition gradually improved and discharged on 2.7.19. He was referred to Department of Neurosurgery for cerebral revascularization by STA-MCA (superficial temporal and middle cerebral arteries) bypass surgery after stabilization and MR perfusion study. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 110-113

FEATURES OF HEMODYNAMICS IN HEAD MAGISTRAL AND CEREBRAL ARTERIES IN THE PATIENTS WITH MIGRAINE

2021 ◽  
Vol 74 (10) ◽  
pp. 2489-2493
Author(s):  
Valeriy I. Kalashnikov ◽  
Alexander N. Stoyanov ◽  
Alexander R. Pulyk ◽  
Iryna K. Bakumenko ◽  
Tamara А. Andreeva ◽  
...  
Keyword(s):  
Migraine With Aura ◽  
Migraine Without Aura ◽  
Cerebral Arteries ◽  
Young Patients ◽  
Postgraduate Education ◽  
External Carotid ◽  
Control Group ◽  
Vertebral Arteries ◽  
Hemodynamic Pattern ◽  
Middle Cerebral Arteries

The aim of the study was to Doppler sonography study of the structural and functional state of head magistral arteries (HMA) and cerebral arteries in the patients with various forms of migraine. Materials and methods: We conducted the clinical Doppler examination of 124 young patients (18-45 years old), including 55 men and 69 women in the conditions of the clinical base of the Kharkiv Medical Academy of Postgraduate Education in 2017-2019. The criteria for involvement of patients in the study were: migraine without aura (group 1 – 63 patients), migraine with aura (group 2 – 61 patients) The control group consisted of 45 patients of the corresponding gender and age. The condition of HMA and cerebral arteries was studied using the ultrasound device. Results: The presence of extravasal compressions of vertebral arteries (VA) is typical for the patients with migraine, as well as for some cases of the hypoplasia of the VA in the group of the patients with migraine with aura. In the patients with migraine with aura, there was a decrease in the velocity values in the extracranial VA segments. The velocity values in the external carotid arteries (ECA) were slightly reduced in both groups. The most significant were the changes in the hemodynamics in the middle cerebral arteries (MCA), which were manifested by the pattern of the excessive perfusion in the patients of the migraine without aura and the pattern of the hampered perfusion in the MCA in the patients of the migraine with aura. Conclusions: 1. In the patients with migraine with aura, a decrease in the velocity values in the extracranial segments of the VA was observed, in some cases combined with the hypoplasia of the vertebral artery, the hampered perfusion in middle cerebral arteries. 2. The excessive perfusion in middle cerebral arteries is the most critical hemodynamic pattern in the patients with migraine without aura. 3. The extravasal compression of vertebral arteries, combined with the hyperperfusion in posterior cerebral arteries, is a typical hemodynamic pattern both in the group of the patients with migraine with aura, and in the group of the patients with migraine without aura.

Postintravenous immunoglobulin stroke in a toddler with Down syndrome: a diagnostic challenge

2020 ◽  
Vol 13 (5) ◽  
pp. e233149 ◽  
Author(s):  
Teck-Hock Toh ◽  
Everlyn Coxin Siew ◽  
Chae-Hee Chieng ◽  
Hussain Imam Mohd Ismail
Keyword(s):  
Down Syndrome ◽  
Cerebral Arteries ◽  
Severe Pneumonia ◽  
Cerebral Vessels ◽  
Partial Recovery ◽  
Diagnostic Challenge ◽  
Middle Cerebral Arteries ◽  
Collateral Vessels ◽  
Carotid Doppler

Children with Down syndrome have a higher risk of stroke. Similarly, intravenous immunoglobulin (IV Ig) is also known to cause a stroke. We reported a 3-year-old boy with Down syndrome who presented with severe pneumonia and received IV Ig. He developed right hemiparesis 60 hours after the infusion. Blood investigations, echocardiography and carotid Doppler did not suggest vasculitis, thrombophilia or extracranial dissection. Brain computerised tomography (CT) showed acute left frontal and parietal infarcts. Initial magnetic resonance angiography (MRA) of cerebral vessels showed short segment attenuations of both proximal middle cerebral arteries and reduction in the calibre of bilateral supraclinoid internal carotid arteries. The boy was treated with enoxaparin and aspirin. He only had partial recovery of the hemiparesis on follow-up. A repeat MRA 13 months later showed parenchymal collateral vessels suggestive of moyamoya disease. We recommend imaging the cerebral vessels in children with a high risk of moyamoya before giving IV Ig.

scholarly journals Acceleration-selective Arterial Spin-labeling MR Angiography Used to Visualize Distal Cerebral Arteries and Collateral Vessels in Moyamoya Disease

Radiology ◽  
2018 ◽  
Vol 286 (2) ◽  
pp. 611-621 ◽  
Author(s):  
Osamu Togao ◽  
Akio Hiwatashi ◽  
Makoto Obara ◽  
Koji Yamashita ◽  
Kazufumi Kikuchi ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Arterial Spin Labeling ◽  
Mr Angiography ◽  
Cerebral Arteries ◽  
Spin Labeling ◽  
Collateral Vessels

Arteriovenous malformation in the posterior fossa supplied by the external carotid circulation

1974 ◽  
Vol 41 (4) ◽  
pp. 502-507 ◽  
Author(s):  
Carl J. Graf ◽  
Arnold H. Menezes
Keyword(s):  
Carotid Artery ◽  
Arteriovenous Malformation ◽  
Posterior Fossa ◽  
Blood Supply ◽  
External Carotid Artery ◽  
External Carotid ◽  
Content Type ◽  
Carotid Circulation ◽  
Fine Print

✓ The authors report a case in which the blood supply of a posterior fossa arteriovenous malformation was derived entirely from the external carotid artery.

scholarly journals The Innervation and Vascular Supply of the Antrum

1934 ◽  
Vol 27 (6) ◽  
pp. 745-751 ◽  
Author(s):  
Cecil Strong
Keyword(s):  
Carotid Artery ◽  
Prussian Blue ◽  
Blood Supply ◽  
Vascular Supply ◽  
External Carotid Artery ◽  
External Carotid ◽  
Antral Mucosa ◽  
Thermal Tests ◽  
Made In

An attempt has been made to obtain information about the condition of the pulp of teeth, immediately below the bony incision, made in the lateral antral wall in radical antrotomy, and to investigate the conditions obtaining in the vascular supply of that neighbourhood. The investigation has two parts: (1) Experimental; (2) Clinical. Experimental.—( a) Injections of specimens of the superior maxillæ were made with lipiodol, then X-rayed. These showed vascular anastomoses along the antral floor. ( b) Sections of the lateral antral wall and floor were cut and stained to show nerves and blood spaces. ( c) The external carotid artery was injected with Prussian Blue and the maxilla then removed. ( d) Transverse sections of the teeth denervated were cut and their pulps examined. Clinical.—The patients who had been submitted to operation were taken, and their teeth examined by:— ( a) Transillumination. ( b) Percussion. ( c) Thermal tests. ( d) Faradic currents. ( e) Radiography. From these investigations it appears that the teeth are denervated but not devitalized by the trauma to the lateral antral wall above their apices. Their blood-supply is still present, and probably comes through a collateral anastomosis, along the antral floor and partly through the antral mucosa.

Caspase-3-dependent Apoptosis in Middle Cerebral Arteries in Patients with Moyamoya Disease

Neurosurgery ◽  
2006 ◽  
Vol 59 (4) ◽  
pp. 894-901 ◽  
Author(s):  
Yasushi Takagi ◽  
Ken-ichiro Kikuta ◽  
Nobutake Sadamasa ◽  
Kazuhiko Nozaki ◽  
Nobuo Hashimoto
Keyword(s):  
Moyamoya Disease ◽  
Caspase 3 ◽  
Cerebral Arteries ◽  
Middle Cerebral Arteries

Suspicious Extracranial Duplex Examination: A Predictor of Intracranial Disease?

2009 ◽  
Vol 33 (1) ◽  
pp. 31-35
Author(s):  
Esther Collado ◽  
Megan Hodge ◽  
Charles McCollum ◽  
George Noon ◽  
Ruth L. Bush ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
Moyamoya Disease ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
Left Vertebral Artery ◽  
External Carotid ◽  
Carotid Duplex ◽  
Doppler Signals

Introduction Moyamoya disease is a rare and progressive condition with poor long-term prognosis. A meticulous evaluation during an extracranial carotid duplex exam, with attention to subtle changes in anatomy and Doppler signals, can alert the sonographer to pathology in the intracranial circulation, which may suggest this diagnosis. Case Report A 45-year-old woman presented to our vascular lab with an episode of slurred speech, right arm weakness, right-sided numbness, and generalized weakness that lasted 15 – 20 min, with total resolution of symptoms. A carotid duplex examination was ordered and demonstrated no evidence of extracranial carotid disease; however, bilaterally the external carotid artery was larger in size than the internal carotid artery, multiple prominent external carotid artery branches were noted, the internal carotid artery and vertebral artery Doppler signals demonstrated low-resistance waveforms with high diastolic flow velocity, and the left vertebral artery was enlarged. Magnetic resonance imaging with angiography demonstrated multiple intracranial abnormalities, and conventional angiography was compatible with Moyamoya disease. A superficial temporal artery-to-middle cerebral artery bypass was performed with an uneventful postoperative course and no recurrence of symptoms. Conclusions Subtle changes in anatomy and Doppler signals observed during an extracranial carotid duplex examination can be important indicators of pathology in a location that is not under direct visualization and interrogation. It is important for the sonographer to note these changes and report them to the physician for further evaluation by more direct methods of testing. This case provides an example of the use of such indirect sonographic evidence.

Sign in / Sign up

Export Citation Format

Share Document