Analysis of Factors Related to Cerebral Infarction after Direct Bypass Surgery in Adults with Moyamoya Disease

Objective: High-risk factors of the patients with moyamoya disease (MMD) were analyzed to provide the basis for prediction and management of cerebral infarction after direct bypass surgery in adult MMD. Methods: 1. Retrospective analysis of clinical data was collected from adult MMD patients (n = 250) following superficial temporal artery-middle cerebral artery bypass surgery performed in our hospital from July 2013 to December 2017. Of the 250 patients, all underwent hemispherical bypass surgery, and bilateral surgery was performed on 14 patients. 2. Clinical data were analyzed based on sex, age, hypertension, diabetes, smoking history, history of alcohol use, presurgery cerebral infarction, transient ischemic attack, classification of clinical manifestations, clinical typing, Suzuki stage of surgical side, Suzuki stage of nonoperative side, preoperative Modified Rankin Scale (MRS), and lesions of the postoperative cycle or not. Results: 1. There were significant differences in classification of clinical manifestations, preoperative infarction, clinical typing, and Suzuki stage of nonoperative side (p < 0.05). 2. Logistic regression analysis showed that the independent factors affecting postoperative cerebral infarction were preoperative infarction and the Suzuki stage of nonoperative side (p < 0.05). The preoperative infarction (B 1.431, OR 4.184, 95% CI 1.217–14.382) and the Suzuki stage of nonoperative side (B 0.495, OR 1.640, 95% CI 1.207–2.227) were both risk factors. Conclusion: The possibility of a new cerebral infarction in postoperative patients with a history of cerebral infarction was greater. The Suzuki stages (I–VI) of the nonoperative side was higher and associated with an increased probability of cerebral infarction after surgery.

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Long-term natural history of hemorrhagic type moyamoya disease in 42 patients

Journal of Neurosurgery ◽

10.3171/jns.2000.93.6.0976 ◽

2000 ◽

Vol 93 (6) ◽

pp. 976-980 ◽

Cited By ~ 132

Author(s):

Eiichi Kobayashi ◽

Naokatsu Saeki ◽

Hiromichi Oishi ◽

Shinji Hirai ◽

Akira Yamaura

Keyword(s):

Risk Factors ◽

Natural History ◽

Moyamoya Disease ◽

Bypass Surgery ◽

Bleeding Episode ◽

Content Type ◽

History Of ◽

Fine Print

Object. The purpose of this study was to delineate the long-term natural history of hemorrhagic moyamoya disease (MMD).Methods. A retrospective review was conducted among 42 patients suffering from hemorrhagic MMD who had been treated conservatively without bypass surgery. The group included four patients who had undergone indirect bypass surgery after an episode of rebleeding. The follow-up period averaged 80.6 months. The clinical features of the first bleeding episode and repeated bleeding episodes were analyzed to determine the risk factors of rebleeding and poor outcome.Intraventricular hemorrhage with or without intracerebral hemorrhage was a dominant finding on computerized tomography scans during the first bleeding episode in 29 cases (69%). During the follow-up period, 14 patients experienced a second episode of bleeding, which occurred 10 years or longer after the original hemorrhage in five cases (35.7%). The annual rebleeding rate was 7.09%/person/year. The second bleeding episode was characterized by a change in which hemisphere bleeding occurred in three cases (21.4%) and by the type of bleeding in seven cases (50%). After rebleeding the rate of good recovery fell from 45.5% to 21.4% and the mortality rate rose from 6.8% to 28.6%. Rebleeding and patient age were statistically significant risk factors of poor outcome. All four patients in whom there was indirect revascularization after the second bleeding episode experienced a repeated bleeding episode within 8 years.Conclusions. The occurrence of rebleeding a long time after the first hemorrhagic episode was not uncommon. Furthermore, the change in which hemisphere and the type of bleeding that occurred after the first episode suggested the difficulty encountered in the prevention of repeated hemorrhage.

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Risk Factors for Early Seizure After Revascularization in Patients With Moyamoya Disease

10.21203/rs.3.rs-789530/v1 ◽

2021 ◽

Author(s):

Hongchuan Niu ◽

Cunxin Tan ◽

Kehan Jin ◽

Ran Duan ◽

Guangchao Shi ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Cerebral Infarction ◽

Moyamoya Disease ◽

Logistic Regression Analysis ◽

History Of ◽

Independent Risk Factors ◽

Postoperative Seizure ◽

Early Seizure

Abstract Background To investigate the risk factors of early seizure after revascularization in patients with moyamoya disease (MMD). Methods A total of 298 patients with MMD diagnosed in our hospital from 2015 to 2018 were analyzed retrospectively. We summarized the characteristics of seizure after revascularization in patients with MMD and analyzed the predictors of early postoperative seizure. Results We identified 15 patients with MMD who developed seizures within 1 week after revascularization. According to logistic regression analysis, age (OR:1.04, 95% CI 0.998–1.086; P = 0.060), and infarct side (OR:1.92, 95% CI 0.856–4.290; P = 0.113) were not significantly associated with incident early seizure. Postoperative infarction (OR:12.89, 95% CI 4.198–39.525; P = 0.000) and preoperative cerebral infarction (OR:4.08, 95% CI 1.267–13.119; P = 0.018) were confirmed as risk factors for early seizure. Conclusions We believe that history of preoperative infarction and new infarction are independent risk factors of early seizure in patients with MMD after revascularization.

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The physiopathology of spontaneous hemorrhagic stroke: a systematic review

Reviews in the Neurosciences ◽

10.1515/revneuro-2020-0131 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Alcivan Batista de Morais Filho ◽

Thiago Luis de Holanda Rego ◽

Letícia de Lima Mendonça ◽

Sulyanne Saraiva de Almeida ◽

Mariana Lima da Nóbrega ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Natural History ◽

Hemorrhagic Stroke ◽

Recent Literature ◽

Clinical Manifestations ◽

The Road ◽

History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

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Challenging direct bypass surgery for very young children with moyamoya disease: technical notes

Neurosurgical Review ◽

10.1007/s10143-021-01685-0 ◽

2021 ◽

Author(s):

Yoshio Araki ◽

Kenji Uda ◽

Kinya Yokoyama ◽

Fumiaki Kanamori ◽

Michihiro Kurimoto ◽

...

Keyword(s):

Young Children ◽

Moyamoya Disease ◽

Bypass Surgery ◽

Very Young Children ◽

Direct Bypass

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Analytical epidemiology of multiple sclerosis in the Republic of Kabardino-Balkaria

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2021-1s-10-14 ◽

2021 ◽

Vol 13 (1S) ◽

pp. 10-14

Author(s):

L. B. Tlapshokova ◽

A. R. Zikhova

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Environmental Factors ◽

Scarlet Fever ◽

Disease Onset ◽

Clinical Manifestations ◽

Control Group ◽

Place Of Residence ◽

History Of ◽

The Republic

Multiple sclerosis (MS) is a common autoimmune disease, which etiology includes a complex of genetic and environmental factors. Data suggests that their interaction can influence the age of the clinical manifestations and the course of the disease. Therefore, the study of risk factors of MS in regions with different ethnic compositions of the population and climatic and geographical characteristics is of considerable interest.Objective: to study MS risk factors prevalence in the Republic of Kabardino-Balkaria (RKB).Patients and methods. This case-control study of the representation of risk factors included a cohort of 112 MS patients living in two regions of the RKB (Nalchik and the Prokhladnensky district). The MS diagnosis was established with the McDonald criteria (2017). MS risk factors were assessed with a unified questionnaire. 112 respondents (matched by the main demographic characteristics and place of residence) were included in the control group.Results and discussion. MS patients from the Prokhladnensky district were significantly more likely to contact harmful chemical compounds, had higher consumption of smoked meat products; and suffered from viral infections more often (all differences were significant, p<0.05). More patients with MS, regardless of their place of residence, had a history of scarlet fever than the controls (n=23; 19.5% and n=14; 13.4%, ratio indicator 0.43 (95% CI 0.32–1.01), p=0.041), and the maximum significance of this factor was found in patients who suffered from scarlet fever after the age of 15 years (n=7; 6.3% and n=1; 0.9%, ratio indicator 2.45 (95% CI 1.92–3.21), p=0.041). More patients with MS had a history of chickenpox (n=70; 62.5% and n=55; 41.1%; ratio indicator 0.78 (95% CI 0.65–0.94, p=0.032), the frequency of this factor was most significant in early (up to 7 years) disease onset. Regardless of the place of residence, patients with MS were more likely to suffer from tonsillitis and sinusitis in childhood (p=0.032).Conclusion. In the RKB, as in other regions of the Russian Federation, the risk of MS, along with a genetic predisposition, is primarily determined by environmental factors, such as contact with potentially harmful chemicals, history of somatic diseases, characteristics of the ecological situation, etc. Therefore, MS risk is higher in people exposed to these factors before the age of 7 years and does not depend on the place of residence.

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Predicting the Occurrence of Hemorrhagic Cerebral Hyperperfusion Syndrome Using Regional Cerebral Blood Flow After Direct Bypass Surgery in Patients with Moyamoya Disease

World Neurosurgery ◽

10.1016/j.wneu.2018.07.258 ◽

2018 ◽

Vol 119 ◽

pp. e750-e756 ◽

Cited By ~ 4

Author(s):

Tatsuya Ishikawa ◽

Koji Yamaguchi ◽

Akitsugu Kawashima ◽

Takayuki Funatsu ◽

Seiichiro Eguchi ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Moyamoya Disease ◽

Regional Cerebral Blood Flow ◽

Bypass Surgery ◽

Regional Cerebral Blood ◽

Cerebral Hyperperfusion Syndrome ◽

Hyperperfusion Syndrome ◽

Cerebral Hyperperfusion ◽

Direct Bypass

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Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults

Journal of Neurosurgery ◽

10.3171/2016.11.jns161688 ◽

2018 ◽

Vol 128 (3) ◽

pp. 793-799 ◽

Cited By ~ 38

Author(s):

Jin Pyeong Jeon ◽

Jeong Eun Kim ◽

Won-Sang Cho ◽

Jae Seung Bang ◽

Young-Je Son ◽

...

Keyword(s):

Moyamoya Disease ◽

Stroke Prevention ◽

Fixed Effects ◽

Bypass Surgery ◽

Perioperative Complications ◽

Meta Analysis ◽

Surgical Techniques ◽

Treatment Modalities ◽

Fixed Effects Model ◽

Direct Bypass

OBJECTIVEThe purpose of this study was to evaluate treatment outcomes of future stroke prevention, perioperative complications, and angiographic revascularization in adults with symptomatic moyamoya disease (MMD) according to treatment modalities and surgical techniques.METHODSA systemic literature review was performed based on searches of the PubMed, Embase, and Cochrane Central databases. A fixed-effects model was used in cases of heterogeneity less than 50%. Publication bias was determined by Begg’s funnel plot, Egger’s test of the intercept, and the Begg and Mazumdar rank correlation test.RESULTSEleven articles were included in the meta-analysis. Bypass surgery significantly decreased the future stroke events compared with conservative treatments in adult MMD (odds ratio [OR] 0.301, p < 0.001). Direct bypass showed better future stroke prevention than indirect bypass (OR 0.494, p = 0.028). There was no meaningful difference in perioperative complications between direct and indirect bypass (OR 0.665, p = 0.176). Direct bypass was associated with better angiographic outcomes than indirect bypass (OR 6.832, p < 0.001).CONCLUSIONSBypass surgery can be effective in preventing future stoke events in adults with MMD. Direct bypass seems to provide better risk reduction with respect to stroke than indirect bypass in these patients.

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