scholarly journals Successful multiple burr hole openings for limb-shaking transient ischemic attack due to moyamoya disease: illustrative case

2021 ◽  
Vol 2 (10) ◽  
Author(s):  
Yusuke Ikeuchi ◽  
Noriaki Ashida ◽  
Masamitsu Nishihara ◽  
Kohkichi Hosoda
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Cerebral Angiography ◽  
Artery Stenosis ◽  
Burr Hole ◽  
Illustrative Case ◽  
Complete Occlusion ◽  
Involuntary Movements ◽  
The Right ◽  
Limb Shaking

BACKGROUND Limb-shaking transient ischemic attacks (LS-TIAs) are a rare form of TIAs that present as involuntary movements of the limbs and indicate severe cerebral hypoperfusion. LS-TIAs are often reported in patients with carotid artery stenosis but can also affect patients with intracranial artery stenosis and moyamoya disease (MMD). OBSERVATIONS A 72-year-old woman presented with repeated episodes of involuntary shaking movements of the right upper limb. Cerebral angiography revealed complete occlusion of the M1 segment of the left middle cerebral artery (MCA), and the left hemisphere was supplied by moyamoya vessels. She was treated with left direct revascularization without complications, and her involuntary movements subsided. However, she demonstrated involuntary shaking movements of the right lower limb 2 months postoperatively. Cerebral angiography revealed complete occlusion of the A1 segment of the left anterior cerebral artery (ACA). The multiple burr hole opening (MBHO) procedure was performed to improve perfusion in the left ACA territory and after 3 months, the patient’s symptoms resolved. LESSONS This case demonstrated that LS-TIAs can also develop as ischemic symptoms due to MMD. Moreover, instances of LS-TIA of the upper and lower limbs developed separately in the same patient. The patient’s symptoms improved with direct revascularization and MBHO.

Hemodynamic changes in limb shaking TIA associated with anterior cerebral artery stenosis

Neurology ◽  
2004 ◽  
Vol 63 (8) ◽  
pp. 1519-1521 ◽  
Author(s):  
S. W. Han ◽  
S. H. Kim ◽  
J. K. Kim ◽  
C. H. Park ◽  
M. J. Yun ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Stenosis ◽  
Hemodynamic Changes ◽  
Limb Shaking

Cranial burr hole for revascularization in moyamoya disease

1989 ◽  
Vol 71 (2) ◽  
pp. 180-185 ◽  
Author(s):  
Masataka Endo ◽  
Nobuyuki Kawano ◽  
Yoshio Miyasaka ◽  
Kenzoh Yada
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Clinical Symptoms ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Burr Hole ◽  
Frontal Region ◽  
External Carotid ◽  
Content Type ◽  
Made In

✓ Currently, superficial temporal artery-middle cerebral artery (MCA) anastomosis, encephalomyosynangiosis (EMS), and encephalo-duro-arterio-synangiosis are used to treat moyamoya disease and are reported to effectively improve ischemic symptoms. All are methods of reversing the flow of blood from the external carotid artery system into the cortical branches of the MCA. As moyamoya disease advances, these operations alone will predictably not correct the deterioration in blood flow in the territory of the anterior cerebral artery. It was noted in a case of moyamoya disease with intraventricular hemorrhage that a burr hole, made in the frontal region for drainage purposes, induced marked neovascularization. Since then, similar frontal burr holes have been made in five juvenile cases of moyamoya disease; this procedure involved making a burr hole in both frontal bones and incising both the dura and the arachnoid membrane. In two cases a frontal burr hole was placed simultaneously with EMS, and in the others the frontal burr hole was made following EMS. The clinical symptoms improved after the frontal burr hole was made, and dynamic computerized tomography revealed improved circulation in the frontal regions. Together with conventional surgical therapy for juvenile cases of moyamoya disease, this operation is considered beneficial both to the circulation in the frontal region and for the protection of frontal brain function.

Traumatic occlusion of the middle cerebral artery

1973 ◽  
Vol 39 (6) ◽  
pp. 753-756 ◽  
Author(s):  
Charles R. Loar ◽  
William M. Chadduck ◽  
G. Robert Nugent
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Content Type ◽  
Complete Occlusion ◽  
Motorcycle Accident ◽  
The Right ◽  
Fine Print

✓ A case is reported of a patient rendered unconscious in a motorcycle accident. After a 6-hour lucid interval, he became unconscious again, and a left hemiplegia was noted. Arteriography demonstrated complete occlusion of the right middle cerebral artery. Comparable reported cases and theories of pathogenesis are discussed.

scholarly journals Free-floating thrombus and a fragment of atherosclerotic plaque in the lumen of the internal carotid artery – review of 2 cases

2021 ◽  
Vol 35 (1) ◽  
pp. 56-65
Author(s):  
S.V. Konotopchyk ◽  
F.H. Rzayeva ◽  
O.A. Pastushyn ◽  
N.M. Nosenko ◽  
O.Ye. Svyrydiuk ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Atherosclerotic Plaque ◽  
Cerebral Angiography ◽  
Internal Carotid ◽  
Floating Thrombus ◽  
Critical Stenosis ◽  
The Right

Free-floating thrombus or a fragment of atherosclerotic plaque (mobile plaque) in the lumen of the carotid artery is extremely rare. Atherosclerosis is the most common cause underlying their occurrence. The optimal treatment strategy has not been developed, at least in part due to the rarity of observations, as well as the lack of comparative studies between conservative and surgical treatment (carotid artery stenting, endovascular thrombectomy, endarterectomy). We present two cases that demonstrate the treatment tactics of these rather rare pathologies. Patient Yu., 62 years old, was hospitalized with focal neurological symptoms, National Institutes of Health Stroke Scale of 12. According to the CT of the brain, signs of an ischemic stroke in the right middle cerebral artery circulation were detected. Selective cerebral angiography diagnosed thrombosis of the arteries of the precentral and central sulcus of the right middle cerebral artery, critical stenosis of the mouth of the right internal carotid artery, and a free-floating thrombus in its lumen with a fixation point at the level of atherosclerotic plaque, which blocked the lumen of the artery by more than 60 %. Endovascular aspiration of a free-floating thrombus was performed, followed by angioplasty and stenting of critical stenosis with a favorable clinical outcome. Patient L., 73 years old, applied for carotid ultrasonography, during which a mobile atherosclerotic plaque was diagnosed at the level of the bifurcation of the right common carotid artery. Digital selective cerebral angiography confirmed a plaque fragment floating in the lumen of the artery. After applying a loading dose of ticagrelor without complications, an emergency implantation of a carotid stent was performed at the level of the bifurcation of the right common carotid artery.Taking into account the modern possibilities of interventional radiology and a wide range of tools, the endovascular approach to the treatment of complicated atherosclerotic plaque with a floating component or a formed blood clot is the best treatment option with a good safety profile.

Occlusion of the Anterior Cerebral Artery Mimicking a Cerebral Aneurysm: Clinical Presentation and Literature Review

2021 ◽  
Author(s):  
Yang Liu ◽  
Gaochao Guo ◽  
Zhu Lin ◽  
Liming Zhao ◽  
Juha Hernesniemi ◽  
...  
Keyword(s):  
Literature Review ◽  
Middle Cerebral Artery ◽  
Cerebral Aneurysm ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Clinical Presentation ◽  
Disease Patient ◽  
Extensive Literature ◽  
The Right

Abstract Background Intracranial aneurysms may be misdiagnosed with other vascular lesions such as vascular loops, infundibulum, or the stump of an occluded artery (very rare and reported compromising only the middle cerebral artery and the posterior circulation territory). Our aim was to describe a unique case of occlusion of an anterior cerebral artery mimicking a cerebral aneurysm in a probable moyamoya disease patient, and to highlight its clinical presentation, diagnosis, and management, and to perform an extensive literature review. Case A 67-year-old man suffering from recurrent dizziness for 3 months. Previous medical history was unremarkable. Brain magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) demonstrated occlusion of the right middle cerebral artery (MCA) associated with a “probable moyamoya disease” and an aneurysm-like shadow protruding lesion at the anterior communicating artery (AcomA). Perfusion images showed ischemia along the right temporo-occipital lobe. Due to MCA occlusion with perfusion deficits and unspecific symptoms, we offered a right side encephalo-duro-myo-synangiosis (EDMS) and clipping of the AcomA aneurysm in one session. Intraoperatively, there was no evidence of the AcomA aneurysm; instead, this finding corresponded to the stump of the occluded right anterior cerebral artery (A1 segment). This segment appeared to be of yellowish color due to atherosclerosis and lacked blood flow. The patient underwent as previously planned a right side EDMS and the perioperative course was uneventful without the presence of additional ischemic attacks. Conclusion Arterial branch occlusions can sometimes present atypical angiographic characteristics that can mimic a saccular intracranial aneurysm. It is relevant to consider this radiographic differential diagnosis, especially when aneurysm treatment is planned.

scholarly journals Progression of isolated middle cerebral artery stenosis into moyamoya disease

Neurology ◽  
2007 ◽  
Vol 68 (12) ◽  
pp. 954-954 ◽  
Author(s):  
H.-Y Choi ◽  
J. E. Lee ◽  
Y. H. Jung ◽  
H. J. Cho ◽  
D. J. Kim ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Artery Stenosis ◽  
Middle Cerebral Artery Stenosis

Transdural Anastomotic Aneurysm in Association with Moyamoya Disease: A Rare and Troublesome Neurosurgical Entity

2021 ◽  
Author(s):  
Kun Hou ◽  
Kan Xu ◽  
Yuhao Zhao ◽  
Jinlu Yu
Keyword(s):  
Literature Review ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Transarterial Embolization ◽  
Spontaneous Remission ◽  
Occipital Artery ◽  
Illustrative Case ◽  
Maxillary Artery ◽  
Anastomotic Aneurysm

AbstractMoyamoya disease (MMD) is an idiopathic progressive steno-occlusive disease in the internal carotid artery (ICA) bifurcation. In rare circumstances, transdural anastomotic aneurysm (TAA) could develop during the progression of MMD. We present an illustrative case of TAA in association with MMD. To further explore this rare entity, a comprehensive literature review was also conducted. Our illustrative patient experienced spontaneous remission of the aneurysm during follow-up. By literature review, 12 patients with 13 TAAs, including our case, were identified. The patients aged from 10 to 74 years (46.3 ± 17.4). Eleven (92%) of the patients presented with intracranial hemorrhage, and 1 TAA (8%) was incidentally found. The responsible transdural collaterals were from the middle meningeal artery, occipital artery, internal maxillary artery, and ophthalmic artery in 8 (66.7%), 2 (16.7%), 1 (8%), and 2 (17%) patients, respectively. The anastomosed cerebral arteries were middle cerebral artery, anterior cerebral artery, posterior cerebral artery, and ICA in 5 (42%), 3 (25%), 3 (25%), and 1 (8%) patient, respectively. Eight (67%) patients underwent open surgeries. Two (17%) patients underwent transarterial embolization (TAE) only. Two (17%) patients experienced spontaneous remission of the aneurysm. Seven (58%) patients died or had neurologic deficits. TAAs rarely occur in the progression of MMD, which often presents with intracranial bleeding. Invasive management through open surgery or endovascular treatment is warranted to prevent catastrophic rebleeding. As some individuals might experience spontaneous aneurysm remission, conservative treatment and close imaging follow-up could be considered as an alternative when invasive treatment is risky.

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