scholarly journals Limb-shaking syndrome derived from the contralateral hemisphere following unilateral revascularisation for moyamoya disease

2021 ◽  
Vol 12 ◽  
pp. 579
Author(s):  
Munehiro Demura ◽  
Masahiro Oishi ◽  
Naoyuki Uchiyama ◽  
Masanao Mohri ◽  
Katsuyoshi Miyashita ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Clinical Symptoms ◽  
Single Photon ◽  
Involuntary Movement ◽  
Photon Emission ◽  
Frontal Lobes ◽  
Cerebral Stroke ◽  
Emission Computed Tomography ◽  
Contralateral Hemisphere ◽  
Limb Shaking

Background: Moyamoya disease is a rare chronic steno-occlusive cerebrovascular disease. It may have variable clinical symptoms associated with cerebral stroke, including motor paralysis, sensory disturbances, seizures, or headaches. However, patients with moyamoya disease rarely present with involuntary movement disorders, including limb-shaking syndrome, with no previous reports of limb-shaking syndrome occurring after revascularization procedures for this disease. Although watershed shifts can elicit transient neurological deterioration after revascularisation, symptoms originating from the contralateral hemisphere following the revascularization procedure are rare. Here, we report the case of moyamoya disease wherein the patient developed limb-shaking syndrome derived from the contralateral hemisphere after unilateral revascularisation. Case Description: A 16-year-old girl presented with transient left upper and lower limb numbness and headache. Based on digital subtraction angiography, she was diagnosed with symptomatic moyamoya disease. Single-photon emission computed tomography (SPECT) showed decreased cerebral blood flow (CBF) on the right side, and she underwent direct and indirect bypasses on this side. Involuntary movements appeared in her right upper limb immediately postoperatively. SPECT showed decreased CBF to the bilateral frontal lobes. Subsequently, the patient was diagnosed with limb-shaking syndrome. After performing left-hemispheric revascularisation, the patient’s symptoms resolved, and SPECT imaging confirmed improvements in CBF to the bilateral frontal lobes. Conclusion: Revascularization for moyamoya disease can lead to watershed shifts, which can induce limb-shaking syndrome derived from abnormalities in the contralateral hemisphere of the revascularized side. For patients with new-onset limb-shaking syndrome after moyamoya revascularisation procedures, additional revascularization may be warranted for treatment of low perfusion areas.

Hemichorea due to hemodynamic ischemia associated with extracranial carotid artery stenosis

2006 ◽  
Vol 105 (1) ◽  
pp. 142-147 ◽  
Author(s):  
Ryoma Morigaki ◽  
Masaaki Uno ◽  
Atsuhiko Suzue ◽  
Shinji Nagahiro
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Single Photon ◽  
Photon Emission ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Emission Computed Tomography ◽  
Vascular Reserve ◽  
Limb Shaking ◽  
Photon Emission Computed Tomography

✓ In this paper the authors describe two patients with recurrent hemiparesis and limb shaking that gradually progressed to hemichorea. Cerebral angiography confirmed severe unilateral internal carotid artery stenosis (95%) contra-lateral to the hemichorea. The cerebral blood flow, assessed using N-isopropyl-p-(iodine-123) iodoamphetamine single-photon emission computed tomography (SPECT), disclosed markedly decreased vascular reserves in both patients. After carotid endarterectomy was performed, the hemichorea gradually subsided and SPECT confirmed increased cerebral perfusion. The results in these cases indicate that surgical revascularization is effective for hemichorea due to cerebral ischemia with reduced vascular reserve.

Minocycline Prevents Focal Neurological Deterioration Due to Cerebral Hyperperfusion After Extracranial-Intracranial Bypass for Moyamoya Disease

Neurosurgery ◽  
2013 ◽  
Vol 74 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Miki Fujimura ◽  
Kuniyasu Niizuma ◽  
Takashi Inoue ◽  
Kenichi Sato ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Moyamoya Disease ◽  
Single Photon ◽  
Ischemia Reperfusion ◽  
Superficial Temporal Artery ◽  
Photon Emission ◽  
Postoperative Management ◽  
Neurological Deterioration ◽  
Emission Computed Tomography ◽  
Cerebral Hyperperfusion

Abstract BACKGROUND: Cerebral hyperperfusion (CHP) is a potential complication of superficial temporal artery–middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD), and optimal postoperative management has not yet been established. Minocycline, a neuroprotective antibiotic agent, plays a role in blocking matrix metalloproteinase 9 (MMP-9), which contributes to edema formation and hemorrhagic conversion after cerebral ischemia-reperfusion. Patients with MMD have been shown to have increased serum MMP-9 levels. OBJECTIVE: To examine the effect of minocycline on the prevention of postoperative CHP after STA-MCA anastomosis for MMD. METHODS: N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 109 hemispheres in 86 consecutive patients with MMD (ages, 9-69 years; mean, 37.2 years). Postoperative systolic blood pressure was strictly maintained at lower than 130 mm Hg in all 109 surgeries. The most 60 recent hemispheres were managed by the intraoperative and postoperative intravenous administration of minocycline hydrochloride (200 mg/d). The incidence of focal neurological deterioration (FND) due to CHP was then compared with that in 36 patients undergoing 49 surgeries managed without minocycline. RESULTS: FND due to CHP was observed in 4 operated hemispheres in patients treated without minocycline (4/49, 8.16%), and in none in the minocycline-treated group (0/60) (P = .0241). Multivariate analysis revealed that minocycline administration (P < .001), surgery on the left hemisphere (P = .031), and a smaller recipient artery diameter (P < .001) significantly correlated with FND due to CHP. CONCLUSION: The administration of minocycline with strict blood pressure control may represent secure and effective postoperative management to prevent symptomatic CHP after STA-MCA anastomosis for MMD.

scholarly journals Characteristic Pattern of the Cerebral Hemodynamic Changes in the Acute Stage After Combined Revascularization Surgery for Adult Moyamoya Disease: N-isopropyl-p-[123I] iodoamphetamine Single-Photon Emission Computed Tomography Study

2021 ◽  
pp. 57-61
Author(s):  
Miki Fujimura ◽  
Teiji Tominaga
Keyword(s):  
Computed Tomography ◽  
Moyamoya Disease ◽  
Single Photon ◽  
Photon Emission ◽  
Acute Stage ◽  
Emission Computed Tomography ◽  
Cerebral Hemodynamic ◽  
Single Photon Emission Computed ◽  
Revascularization Surgery ◽  
Photon Emission Computed Tomography

AbstractObjective: Surgical revascularization for moyamoya disease (MMD) prevents cerebral ischemic attack by improving cerebral blood flow (CBF) and could also reduce the risk of re-bleeding in hemorrhagic-onset patients. We sought to clarify the cerebral hemodynamic changes in the acute stage after revascularization surgery for adult MMD.Materials and methods: The present study includes 54 consecutive adult patients with MMD (21–76 years old, 43.1 average), undergoing superficial temporal artery-middle cerebral artery anastomosis with indirect pial synangiosis on 65 affected hemispheres. We prospectively performed single-photon emission computed tomography (SPECT) at postoperative day (POD) 1 and 7 of 65 surgeries. Perioperative management was conducted with strict blood pressure control (100–130 mmHg) and minocycline hydrochloride administration.Results: The outcome of 65 surgeries was favorable except for one (1.5%), which manifested as delayed intracerebral hemorrhage due to local hyperperfusion. The postoperative SPECT revealed the characteristic CBF improvement pattern with transient local hyperperfusion (POD1) and subsequent distribution of CBF in wider vascular territory (POD7) on 37 hemispheres (56.9%, 37/65).Conclusion: The revascularization surgery is a safe and effective treatment for adult MMD, while transient local hyperperfusion should be strictly managed by intensive perioperative care.

Significance of Focal Cerebral Hyperperfusion as a Cause of Transient Neurologic Deterioration After Extracranial-Intracranial Bypass for Moyamoya Disease: Comparative Study With Non-Moyamoya Patients Using N-Isopropyl-p-[123I]Iodoamphetamine Single-Photon Emission Computed Tomography

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. 957-965 ◽  
Author(s):  
Miki Fujimura ◽  
Hiroaki Shimizu ◽  
Takashi Inoue ◽  
Shunji Mugikura ◽  
Atsushi Saito ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Potential Complication ◽  
Single Photon Emission ◽  
Neurological Signs ◽  
Cerebral Hyperperfusion ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography

Abstract BACKGROUND: Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis prevents cerebral ischemic attack by improving cerebral blood flow in patients with occlusive cerebrovascular disease and hemodynamic compromise. Recent evidence suggests that focal cerebral hyperperfusion is a potential complication of this procedure for moyamoya disease. OBJECTIVE: To clarify the exact differences in the incidence and clinical manifestations of this phenomenon between patients with and without moyamoya disease. METHODS: N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 121 hemispheres from 86 consecutive patients with moyamoya disease (2–67 years of age; mean, 34.3 years) and on 28 hemispheres from 28 non-moyamoya patients (12–67 years of age; mean, 56.5 years). The incidence of symptomatic hyperperfusion, defined as a significant focal increase in cerebral blood flow at the site of the anastomosis that is responsible for the apparent neurological signs, was compared between groups. RESULTS: Symptomatic cerebral hyperperfusion including mild focal neurological signs was seen in 25 patients with moyamoya disease (26 hemispheres, 21.5%) but in none of the patients without moyamoya disease (P = .0069). Multivariate analysis revealed that moyamoya disease was significantly associated with the development of symptomatic cerebral hyperperfusion (P = .0008). All patients with symptomatic hyperperfusion were relieved by intensive blood pressure control, and no patients suffered from permanent neurological deficit caused by hyperperfusion. CONCLUSION: Symptomatic cerebral hyperperfusion is a potential complication of STA-MCA anastomosis, especially in patients with moyamoya disease. Accurate diagnosis and adequate management of hyperperfusion are recommended, especially in patients with moyamoya disease.

scholarly journals Calcium Antagonist (PY 108-068) Treatment May Further Decrease Flow in Ischemic Areas in Acute Stroke

1986 ◽  
Vol 6 (2) ◽  
pp. 222-229 ◽  
Author(s):  
S. Vorstrup ◽  
A. Andersen ◽  
N. Blegvad ◽  
O. B. Paulson
Keyword(s):  
Calcium Antagonist ◽  
Clinical Symptoms ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Before And After ◽  
Single Photon Emission Computed ◽  
Xenon 133 ◽  
Photon Emission Computed Tomography

The effect of the possible influence of a new calcium antagonist, PY 108-068, on regional CBF was studied in patients suffering acute ischemic stroke. The dosage was 1.5 + 2.5 mg intravenously in six patients (series 1) and 2.5 + 5.0 mg intravenously in five other patients (series 2). CBF was measured before and after treatment by xenon-133 inhalation and single-photon emission computed tomography (Tomomatic 64). In the first series, no changes in hemispheric CBF, MABP, or clinical symptoms were noted after treatment, but one patient showed an increase of CBF in part of the periin-farct area. In the second series, slight increases in mean hemispheric flow values were seen, but in three of the five patients CBF decreased even further in the ischemic area. MABP decreased by 13%, and the clinical symptoms were unchanged.

Clinical Characteristics and Neuroimaging Findings in Internal Jugular Venous Outflow Disturbance

2019 ◽  
Vol 119 (02) ◽  
pp. 308-318 ◽  
Author(s):  
Da Zhou ◽  
Jiayue Ding ◽  
Karam Asmaro ◽  
Liqun Pan ◽  
Jingyuan Ya ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Cerebral Perfusion ◽  
Clinical Symptoms ◽  
Single Photon ◽  
Photon Emission ◽  
Clinical Manifestations ◽  
Glucose Consumption ◽  
Emission Computed Tomography ◽  
Subjective Memory

AbstractRecently, internal jugular vein stenosis (IJVS) is gaining increasing attention from clinical researchers due to a series of confounding symptoms that impair the quality of life in affected individuals but cannot be explained by other well-established causes. In this study, we aimed to elucidate the clinical features, neuroimaging characteristics and pathogenesis of IJVS, and explore their possible correlations, in attempt to provide useful clues for clinical diagnosis and treatment. Forty-three eligible patients with unilateral or bilateral IJVS confirmed by contrast-enhanced magnetic resonance venography of the brain and neck were enrolled in this study. Magnetic resonance imaging along with magnetic resonance angiography or computed tomography angiography was applied to identify the radiological pattern of parenchymal or arterial lesions. Cerebral perfusion and metabolism were evaluated by single-photon emission computed tomography (SPECT). Of the 43 patients (46.0 ± 16.0 years old; 30 female), 14 (32.6%) had bilateral and 29 had unilateral IJVS. The common clinical symptoms at admission were tinnitus (60.5%), tinnitus cerebri (67.6%), headache (48.8%), dizziness (32.6%), visual disorders (39.5%), hearing impairment (39.5%), neck discomfort (39.5%), sleep disturbance (60.5%), anxiety or depression (37.5%) and subjective memory decline (30.2%). The presence of bilateral demyelination changes with cloudy-like appearance in the periventricular area and/or centrum semiovale was found in 95.3% (41/43) patients. SPECT findings showed that 92.3% (24/26) patients displayed cerebral perfusion and metabolism mismatch, depicted by bilaterally and symmetrically reduced cerebral perfusion and increased cerebral glucose consumption. IJVS may contribute to alterations in cerebral blood flow and metabolism, as well as white matter lesion formation, all of which may account for its clinical manifestations.

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