Do Direct Bypasses Really Resolve Capillary Vessels in Moyamoya Disease? Delayed Hemorrhage Potentially Relevant to Direct Bypasses: A Pathological Investigation

Objective: Moyamoya disease is a chronic but progressive obliterative cerebrovascular disease of bilateral internal carotid arteries (ICAs) causing hemorrhagic or ischemic cerebral strokes. Surgical revascularization has the potential for resolving the capillary vessels, but the effect on the occlusive ICA and the moyamoya vessels after a direct bypass remains unclear. Patient: A 2-year-old girl with a history of repeated transient ischemic attacks and direct bypasses but demonstrating improvement and associated anomaly is reported. A year and a half later, after a bilateral revascularization, an intracerebral capsulized hematoma growth was identified, and it was removed surgically. Neovascularization including many microvessels similar to capillary telangiectasia were identified by pathological investigation despite the reduction of moyamoya vessels on the repeated angiograms after the revascularization surgeries. In the present case, proliferation of capillary vessels was clearly confirmed by direct bypasses. Conclusion: There is no doubt that direct bypasses prevent further ischemic stroke by improving cerebral blood flow. However, they may result in failure in reducing the load of moyamoya vessels, albeit decreasing the potential risk of hemorrhagic strokes.

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Surgical management of moyamoya disease

Neurosurgical FOCUS ◽

10.3171/2009.01.focus08293 ◽

2009 ◽

Vol 26 (4) ◽

pp. E7 ◽

Cited By ~ 57

Author(s):

Ali A. Baaj ◽

Siviero Agazzi ◽

Zafar A. Sayed ◽

Maria Toledo ◽

Robert F. Spetzler ◽

...

Keyword(s):

Moyamoya Disease ◽

Carotid Arteries ◽

Internal Carotid ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Surgical Options ◽

Direct Bypass ◽

Stenotic Vessel ◽

Internal Carotid Arteries

Moyamoya disease (MMD) is a progressive, occlusive disease of the distal internal carotid arteries associated with secondary stenosis of the circle of Willis. Symptoms include ischemic infarcts in children and hemorrhages in adults. Bypass of the stenotic vessel(s) is the primary surgical treatment modality for MMD. Superficial temporal artery-to-middle cerebral artery bypass is the most common direct bypass method. Indirect techniques rely on the approximation of vascularized tissue to the cerebral cortex to promote neoangiogenesis. This tissue may be in the form of muscle, pericranium, dura, or even omentum. This review highlights the surgical options available for the treatment of MMD.

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Unilateral sudden hearing loss as the first presenting symptom of moyamoya disease

The Journal of Laryngology & Otology ◽

10.1017/s002221511200309x ◽

2013 ◽

Vol 127 (2) ◽

pp. 196-199 ◽

Cited By ~ 1

Author(s):

L-S Tseng ◽

S-D Luo

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Moyamoya Disease ◽

Carotid Arteries ◽

Internal Carotid ◽

Cerebral Arteries ◽

Sudden Onset ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Internal Carotid Arteries

AbstractObjective:We describe a rare case of sudden onset of unilateral sensorineural hearing loss occurring as the first symptom of moyamoya disease, which is characterised by progressive stenosis of the intracranial internal carotid arteries and their proximal anterior cerebral arteries and middle cerebral arteries.Method:Case report and review of the world literature regarding moyamoya disease with hearing loss.Results:The reported patient had moyamoya disease that initially presented as sudden, unilateral sensorineural hearing loss. Magnetic resonance imaging showed occlusion of the anterior cerebral, middle cerebral and distal internal carotid arteries bilaterally. The possible mechanism of this patient's sudden sensorineural hearing loss may have been vascular occlusion resulting from thrombotic narrowing or blockage by plaque.Conclusion:The described patient represents the first reported case of sudden onset, unilateral sensorineural hearing loss occurring as the first symptom of moyamoya disease. The possibility of a vascular lesion such as moyamoya disease should be considered in patients with sudden sensorineural hearing loss, especially children, young adults and Asian patients. Due to this disease's poor outcome, early diagnosis and treatment are important to prevent stroke.

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Moyamoya in Hispanics: not only in Japanese

Neurology International ◽

10.4081/ni.2014.5369 ◽

2014 ◽

Vol 6 (2) ◽

Cited By ~ 2

Author(s):

Sarmad Said ◽

Chad J. Cooper ◽

Haider Alkhateeb ◽

Juan M. Galvis ◽

German T. Hernandez ◽

...

Keyword(s):

Cigarette Smoke ◽

Moyamoya Disease ◽

Carotid Arteries ◽

Internal Carotid ◽

Prolonged Survival ◽

Moyamoya Syndrome ◽

Characteristic Appearance ◽

Hispanic Patients ◽

Collateral Vessels ◽

Internal Carotid Arteries

Moyamoya disease was first described in 1957 as hypoplasia of the bilateral internal carotid arteries, the characteristic appearance of the associated network of abnormally dilated collateral vessels on angiography was later likened to something hazy, like a puff of cigarette smoke, which, in Japanese, is moyamoya. This paper describes two cases of moyamoya presentations, including moyamoya disease and moyamoya syndrome. Moyamoya may rarely occur in North American Hispanic patients. The presentation can vary significantly and ranges bwtween fulminant outcome and prolonged survival. Awareness about moyamoya and its different presentations may be beneficial for the patients and can improve the outcome.

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Cerebral mycotic aneurysm of fungal origin

Journal of Neurosurgery ◽

10.3171/jns.1978.49.1.0107 ◽

1978 ◽

Vol 49 (1) ◽

pp. 0107-0110 ◽

Cited By ~ 40

Author(s):

Gulshan K. Ahuja ◽

Neeraj Jain ◽

Malini Vijayaraghavan ◽

Subimal Roy

Keyword(s):

Subarachnoid Hemorrhage ◽

Mycotic Aneurysm ◽

Carotid Arteries ◽

Internal Carotid ◽

Content Type ◽

History Of ◽

The Right ◽

Internal Carotid Arteries ◽

Fine Print

✓ A young man who had a long history of sinusitis developed subarachnoid hemorrhage and died. Autopsy showed a mycotic aneurysm of fungal origin at the junction of the right posterior cerebral and internal carotid arteries. Four of five reported cases of fungal aneurysm were due to Aspergillus infection.

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Morning glory disk anomaly, choroidal coloboma, and congenital constrictive malformations of the internal carotid arteries (moyamoya disease)

Ophthalmic Genetics ◽

10.1076/1381-6810(200003)21:1;1-i;ft021 ◽

2000 ◽

Vol 21 (1) ◽

pp. 21-24 ◽

Cited By ~ 1

Author(s):

Chadrasekharan Krishnan ◽

Anindiya Roy ◽

Elias I. Traboulsi

Keyword(s):

Moyamoya Disease ◽

Carotid Arteries ◽

Internal Carotid ◽

Morning Glory ◽

Internal Carotid Arteries

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ABNORMAL INTRACRANIAL VASCULAR NETWORKS (“MOYAMOYA” DISEASE), POSSIBLY DUE TO OCCLUSION OF BILATERAL INTERNAL CAROTID ARTERIES - A CASE REPORT WITH HISTOMETRICAL ANALYSIS -

Pathology International ◽

10.1111/j.1440-1827.1976.tb03296.x ◽

1976 ◽

Vol 26 (1) ◽

pp. 105-114

Author(s):

Isao Okayasu ◽

Akira Kajita ◽

Masaaki Yamamoto

Keyword(s):

Case Report ◽

Moyamoya Disease ◽

Carotid Arteries ◽

Internal Carotid ◽

Vascular Networks ◽

Internal Carotid Arteries

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Differences in Clinical Features among Different Onset Patterns in Moyamoya Disease

Journal of Clinical Medicine ◽

10.3390/jcm10132815 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2815

Author(s):

Yudai Hirano ◽

Satoru Miyawaki ◽

Hideaki Imai ◽

Hiroki Hongo ◽

Yu Teranishi ◽

...

Keyword(s):

Clinical Features ◽

Moyamoya Disease ◽

Carotid Arteries ◽

Internal Carotid ◽

Age At Onset ◽

Imaging Features ◽

Radiological Findings ◽

Severe Stenosis ◽

Imaging Characteristics ◽

Internal Carotid Arteries

Moyamoya disease is characterized by severe stenosis at the ends of the bilateral internal carotid arteries and the development of collateral circulation. The disease is very diverse in terms of age at onset, onset patterns, radiological findings, and genetic phenotypes. The pattern of onset is mainly divided into ischemic and hemorrhagic onsets. Recently, the opportunity to identify asymptomatic moyamoya disease, which sometimes manifests as nonspecific symptoms such as headache and dizziness, through screening with magnetic resonance imaging has been increasing. Various recent reports have investigated the associations between the clinical features of different onset patterns of moyamoya disease and the corresponding imaging characteristics. In this article, we have reviewed the natural history, clinical features, and imaging features of each onset pattern of moyamoya disease.

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Morning glory disk anomaly, choroidal coloboma, and congenital constrictive malformations of the internal carotid arteries (moyamoya disease)

Ophthalmic Genetics ◽

10.1076/1381-6810(200003)2111-ift021 ◽

2000 ◽

Vol 21 (1) ◽

pp. 21-24 ◽

Cited By ~ 21

Author(s):

Chadrasekharan Krishnan ◽

Anindiya Roy ◽

Elias I. Traboulsi

Keyword(s):

Moyamoya Disease ◽

Carotid Arteries ◽

Internal Carotid ◽

Morning Glory ◽

Internal Carotid Arteries

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Internal carotid artery redundancy and dissection in a young cocaine abuser

Vascular ◽

10.1177/1708538113478765 ◽

2013 ◽

Vol 21 (4) ◽

pp. 243-245 ◽

Cited By ~ 1

Author(s):

M Meghani ◽

M N Siddique ◽

T Bhat ◽

M Samarneh ◽

S Elsayegh

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cocaine Abuse ◽

Carotid Arteries ◽

Internal Carotid ◽

Imaging Studies ◽

Cocaine Abuser ◽

History Of ◽

The Right ◽

Internal Carotid Arteries

Carotid artery redundancies are common findings on routine imaging studies and are usually considered to be benign variants. We present a case of a 40-year-old man, with a history of cocaine abuse, who was diagnosed with dissection of the right internal carotid artery and looping of the bilateral internal carotid arteries. This report attempts to highlight the possible association between carotid artery redundancy and dissection, especially in the context of vascular injury such as cocaine abuse, as in our case.

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