scholarly journals Clinical Characteristics and Multi-Model Imaging Analysis of Moyamoya Disease: An Observational Study

2021 ◽  
Author(s):  
Bing Qin ◽  
Liansheng Gao ◽  
Weilin Xu ◽  
Tao Li ◽  
Umut Ocak ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Clinical Features ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Clinical Manifestations ◽  
Motor Dysfunction ◽  
Gold Standard Method ◽  
Female Ratio ◽  
Imaging Characteristics ◽  
Aneurysm Embolization

Abstract The study was to analyze the clinical features and imaging characteristics of moyamoya disease (MMD) and to explore the significance of multi-model imaging in the diagnosis of MMD. A retrospective analysis of the clinical features, imaging characteristics, and treatment of 78 adult MMD patients enrolled from March 2010 to March 2013 was performed. The MMD patients in our series were between 23 and 53 years old, and the male to female ratio was 4:1. The main clinical manifestations were sensory abnormalities, headache, and motor dysfunction, depending on the type of MMD. Intracerebral hemorrhage (ICH) was detected in 54 patients (69.2％), cerebral infarction in 20 (25.6％), and ICH together with cerebral infarction in 4 (5.1%). Using computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA), stenotic or occlusive lesions were observed in the internal carotid artery, anterior cerebral artery, and middle cerebral artery. Aneurysms accompanying MMD were found in 17 of the patients (21.8％). Ultimately, 21 patients underwent multiple burr-hole surgery and 57 underwent bypass surgery with or without temporalis muscle sticking. Fourteen patients underwent aneurysm embolization. The clinical manifestations of MMD vary, though the most common is ICH. DSA is the gold standard method for the diagnosis of MMD, and should be performed as early as possible in clinically suspected cases. CTA and MRA are non-invasive techniques used for MMD patient screening and follow-up.

scholarly journals Spectrum of clinical features and neuroimaging findings in acute cerebral infarction patients with unusual ipsilateral motor impairment– a series of 22 cases

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhe-Ren Tan ◽  
Chen Zhang ◽  
Fa-Fa Tian
Keyword(s):  
Cerebral Infarction ◽  
Clinical Features ◽  
Corticospinal Tract ◽  
Past History ◽  
Motor Impairment ◽  
Cortical Reorganization ◽  
Motor Dysfunction ◽  
Cerebral Injury ◽  
Mri Findings ◽  
History Of

Abstract Background Cerebral infarction occurs when the arteries to brain are obstructed, and motor impairment contralateral to responsible lesion is commonly recognized. Few studies have profiled the characteristics of cases with ipsilateral motor impairment. We sought to characterize clinical features of patients with motor dysfunction caused by ipsilateral ischemic stroke. Methods We retrieved and analyzed the medical data for patients with ipsilateral cerebral infarction. Patients were regarded as having ipsilateral cerebral infarction if motor impairment is ipsilateral to recent stroke lesions. Results Only 22 patients with unusual ipsilateral cerebral infarction were included in this study. Ipsilateral limb paralysis was observed in all cases, and one case showed central facioplegia. Majority of patients with limb paralysis (90.9%, 20/22) presented with mild muscle strength deficits (MRC grading of 4 or more). Most of the patients (72.7%, 16/22) had a past history of stroke, and previous strokes were contralateral to the side of the recent stroke in 14 out of 16 patients (87.5%). No history of stroke or cerebral injury was identified in seven patients. With aspect of MRI findings, recent infarct lesions of all cases were located along the corticospinal tract. Conclusions History of stroke plays an important role in the pathogenesis of ipsilateral motor impairment, and cortical reorganization in the unaffected hemisphere may contribute to the compensation of motor function after stroke. Besides that, some cases with first stroke may be due to impairment of ipsilateral uncrossed corticospinal fibers.

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

2020 ◽  
Vol 49 (1) ◽  
pp. 55-61
Author(s):  
Yun Qian ◽  
Bin Huang ◽  
Zongmin Hu ◽  
Jian Wang ◽  
Peng Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Infarction ◽  
Clinical Data ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Clinical Manifestations ◽  
History Of ◽  
Direct Bypass ◽  
Nonoperative Side

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.

Progression in Moyamoya Disease: Clinical Feature, Neuroimaging Evaluation and Treatment

2021 ◽  
Vol 19 ◽  
Author(s):  
Xin Zhang ◽  
Weiping Xiao ◽  
Qing Zhang ◽  
Ding Xia ◽  
Peng Gao ◽  
...  
Keyword(s):  
Clinical Features ◽  
Moyamoya Disease ◽  
Cognitive Rehabilitation ◽  
Clinical Manifestations ◽  
Clinical Feature ◽  
Genetic Characteristics ◽  
Neurological Protection ◽  
Temporal Dimensions ◽  
The Brain ◽  
Neuroimaging Techniques

: Moyamoya disease (MMD) is a chronic cerebrovascular disease characterized by progressive stenosis of the arteries of the circle of Willis, with the formation of the collateral vascular network at the base of the brain. Its clinical manifestations are complicated. Numerous studies have attempted to clarify the clinical features of MMD, including its epidemiology, genetic characteristics, and pathophysiology. With the development of neuroimaging techniques, various neuroimaging modalities with different advantages have deepened the understanding of MMD in structural, functional, spatial, and temporal dimensions. At present, the main treatment for MMD focuses on neurological protection, cerebral blood flow reconstruction, and neurological rehabilitation, such as pharmacological treatment, surgical revascularization, and cognitive rehabilitation. In this review, we discuss recent progress in understanding the clinical features, neuroimaging evaluation, and treatment of MMD.

Analysis of the Value of GE1.5HDX MRI Information Imaging Technology in the Clinical Diagnosis of Patients with Hemorrhagic Cerebral Infarction

2021 ◽  
Vol 11 (1) ◽  
pp. 209-215
Author(s):  
Tiefeng Li ◽  
Ailin Chen ◽  
Pingkun Xie ◽  
Xudong Chen
Keyword(s):  
Cerebral Infarction ◽  
Clinical Data ◽  
Large Scale ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Cerebrovascular Diseases ◽  
Cerebral Embolism ◽  
Imaging Characteristics ◽  
Mri Scans ◽  
Criteria For Diagnosis

Objective: To analyze the imaging characteristics of hemorrhagic cerebral infarction (HI). Methods: The cases were selected from 220 patients with new cerebral infarction who were hospitalized in our hospital from March 2015 to February 2018, of which 34 cases were found with hemorrhagic cerebral infarction. All the selected cases met the criteria for "Diagnosis Points of Various Cerebrovascular Diseases" adopted by the Fourth National Cerebrovascular Diseases Academic Conference of the Chinese Medical Association in 1995, and were confirmed by cranial CT and/or GE1.5HDX MRI scans as Hemorrhagic cerebral infarction. Retrospectively analyze the clinical data, clinical manifestations, brain CT, GE1.5HDX magnetic resonance examination, and clinical data of 34 patients with HI, and analyze their short-term prognosis, HI occurrence time, type of bleeding, infarct area, incidence site, arteries The blood supply and imaging performance were analyzed by statistical X2 test to analyze the imaging characteristics of hemorrhagic cerebral infarction. Results: 1. 34 patients with HI in this group accounted for 15.45% of the cerebral infarction in the same period, including 16 males and 18 females. The ages ranged from 45 to 86 years, with an average of 68.09 ± 10.41 years. 2.34 cases of HI included cerebral embolism in 26 cases (76.47%), cerebral thrombosis in 7 cases (20.58%), lacunar infarction in 1 case (2.94%), cardiogenic cerebral embolism in 22 cases (64.71%), and history of atrial fibrillation. Fourteen patients (41.18%) and 24 patients with large infarction (70.59%). Conclusions: Embolization, occlusion, recanalization, and establishment of collateral circulation are closely related to the occurrence of HI. For patients with cardiogenic cerebral embolism and large-scale cerebral infarction, regardless of whether the clinical symptoms are exacerbated, attention should be paid to cerebral infarction.

scholarly journals Differences in Clinical Features among Different Onset Patterns in Moyamoya Disease

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.

Multimodal treatment approach in a patient with multiple intracranial myxomatous aneurysms

2018 ◽  
Vol 21 (3) ◽  
pp. 315-321 ◽  
Author(s):  
David L. Penn ◽  
Arianna B. Lanpher ◽  
Jennifer M. Klein ◽  
Harry P. W. Kozakewich ◽  
Kristopher T. Kahle ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Left Atrium ◽  
Cerebral Artery ◽  
Cardiac Myxoma ◽  
Clinical Manifestations ◽  
Left Middle Cerebral Artery ◽  
Primary Cardiac Tumor ◽  
The Central Nervous System ◽  
Open Surgical Treatment

The most common primary cardiac tumor is myxoma, typically originating in the left atrium. Emboli to the central nervous system can cause cerebral infarction or, rarely, seed tumor growth within vessel walls, causing myxomatous aneurysms. Fewer than 60 myxomatous aneurysms have been reported, including 2 cases in children. Here, the authors describe 2 different growing myxomatous aneurysms in a child successfully managed using a combined multidisciplinary approach. A 12-year-old boy developed a sudden headache, diplopia, gait instability, and speech difficulty. Magnetic resonance imaging revealed a left parietal hemorrhage and multifocal cerebral infarction, suspicious for an embolic etiology. A cardiac myxoma was identified in the left atrium and resected. Follow-up cranial vasculature imaging demonstrated multiple intracranial myxomatous aneurysms. These lesions were followed up, and serial imaging identified marked growth of 2 of them (right occipital and left parietal), prompting invasive intervention. The deep occipital lesion was better suited to endovascular treatment, while the superficial parietal lesion was amenable to resection. The patient underwent embolization of an enlarging fusiform aneurysm of the distal right posterior cerebral artery, followed by a left parietal craniotomy for a lesion of the distal left middle cerebral artery. Both procedures were performed without complications and achieved successful obliteration of the lesions, as confirmed by catheter angiography at the 30-month follow-up. To the authors’ knowledge, this report illustrates the first combined endovascular and open surgical treatment of 2 myxomatous aneurysms in a single patient. While acknowledging the rarity of this condition, this report illustrates the clinical manifestations and treatment challenges posed by myxoma and details a successful strategy that could be employed in similar scenarios.

scholarly journals Stenotic changes of the posterior cerebral artery are a major contributing factor for cerebral infarction in moyamoya disease

2018 ◽  
Vol 9 (1) ◽  
pp. 105 ◽  
Author(s):  
Motohiro Morioka ◽  
Akira Ohkura ◽  
Tetsuya Negoto ◽  
Takachika Aoki ◽  
Kei Noguchi ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery

Abstract 2413: Postoperative Cerebral Hyperperfusion after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis and Indirect Synangiosis in Moyamoya Disease: PET and SPECT Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Haruto Uchino ◽  
Satoshi Kuroda ◽  
Naoki Nakayama ◽  
Kiyohiro Houkin
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Middle Cerebral Artery ◽  
Clinical Features ◽  
Moyamoya Disease ◽  
Logistic Regression Analysis ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cerebral Hyperperfusion

Background Postoperative cerebral hyperperfusion is known to occur after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect synangiosis in moyamoya disease. However, the clinical features and pathophysiology still remain to be elucidated. Objective To clarify the incidence and pathogenesis of postoperative hyperperfusion after surgical revascularization for moyamoya disease. Methods This study included 41 consecutive patients (58 surgeries) who underwent STA-MCA anastomosis and indirect synangiosis for moyamoya disease. Their medical records were evaluated to identify clinical features of postoperative hyperperfusion. Using 15O-gas positron emission tomography (PET), cerebral hemodynamics and metabolism were determined before surgery in all patients. Using 123I-IMP single photon emission computed tomography (SPECT), cerebral blood flow was qualitatively measured on Day 0, 2, and 7 after surgery in all patients. A multivariate logistic regression analysis was conducted to identify the predictors for postoperative hyperperfusion. Results Postoperative hyperperfusion was observed in 29 (50.0%) of 58 operated sides. In pediatric patients, it was quite rare. Thus, symptomatic and asymptomatic hyperperfusion occurred in 1 (5%) and 3 (15%) of 20 sides, respectively. In adult cases, however, symptomatic and asymptomatic hyperperfusion were significantly more often (P=0.0037 and P=0.026, respectively) and were noted in 12 (31.5%) and 13 (34.2%) of 38 sides, respectively. A logistic regression analysis revealed that cerebral blood volume (CBV) increase before surgery was a significant predictors for symptomatic hyperperfusion in adults (P=0.036). Furthermore, hyperperfusion immediately after surgery was at significantly higher risk to be symptomatic (7/9=77.7%, P=0.033). Conclusions Postoperative hyperperfusion after STA-MCA anastomosis in adult moyamoya disease is not rare. Preoperative CBV increase was closely related to the occurrence of symptomatic hyperperfusion in adult cases. Hyperperfusion immediately after surgery may easily cause neurological deficits or other symptoms. Precise evaluation of cerebral hemodynamics and metabolism before and after surgery would be valuable to predict postoperative hyperperfusion and prevent perioperative complications.

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