scholarly journals Moyamoya: An Uncommon Variant Of Stroke In Childrena

2018 ◽  
Vol 08 (03) ◽  
pp. 194-196
Author(s):  
Rida Zaheer ◽  
Ayesha Ahmed ◽  
Shazia Shakoor ◽  
Shakeel Ahmed
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Conservative Therapy ◽  
Unknown Etiology ◽  
Cerebrovascular Disorder ◽  
Ct Angiogram ◽  
History Of ◽  
The Right

Moyamoya is a rare cause of stroke in children. It is an infrequent cerebrovascular disorder of unknown etiology. We are reporting a case of a 7-year-old girl who presented with an acute history of left-sided weakness. On imaging she was diagnosed with Moyamoya disease. CT Angiogram revealed an occlusion of the right middle cerebral artery typical of Moyamoya disease. The child improved with conservative therapy.

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.

Penetrating Injury Due to Bicycle Brake Handle Causing Middle Cerebral Artery Infarct

2018 ◽  
Vol 15 (02/03) ◽  
pp. 067-069
Author(s):  
Gopalakrishnan Madhavan Sasidharan ◽  
Abhishek Chauhan
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Mass Effect ◽  
Penetrating Injury ◽  
Left Middle Cerebral Artery ◽  
Computed Tomographic ◽  
Ct Angiogram ◽  
History Of ◽  
Titanium Cranioplasty

AbstractAn 8-year-old boy was brought to the emergency room with history of fall from a bicycle he was riding. On examination, he had a swelling in the left orbit with a small laceration under the medial aspect of the left eyebrow. The Glasgow coma scale was E2M5V2. An emergency computed tomographic (CT) scan showed infarct causing mass effect in the territory of the left middle cerebral artery. CT angiogram showed that a branch of the middle cerebral artery was occluded at the end of track traversed by the bicycle brake handle. The patient underwent decompressive craniectomy. Initial methylmethacrylate cranioplasty had to be removed due to infection. Later, the patient underwent titanium cranioplasty. At last follow-up, he was going to school. Hemiparesis persisted. Children are vulnerable to penetrating injury by the relatively sharp brake handle when they fall from an adult bicycle. Previous reports include fatal injury by similar mechanism. In this case, it caused injury to the middle cerebral artery without causing bleed. Bicycle manufacturers could be advised to make the vehicle safer for children by twisting the end of the brake handle.

Aplastic or twig-like middle cerebral artery and cardiogenic cerebral embolism mimicking moyamoya disease with RNF213 polymorphism: A case report

2021 ◽  
pp. 159101992110620
Author(s):  
Hiroyasu Inoue ◽  
Masahiro Oomura ◽  
Yusuke Nishikawa ◽  
Mitsuhito Mase ◽  
Noriyuki Matsukawa
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Acute Stage ◽  
Main Trunk ◽  
Chronic Occlusion ◽  
The Right ◽  
Stenosis And Occlusion ◽  
Rnf213 Gene

Progressive stenosis and occlusion of the bilateral internal carotid artery terminals and circle of Willis are typical features of Moyamoya disease. However, aplastic or twig-like middle cerebral artery (Ap/T-MCA)—wherein the unilateral main trunk of the middle cerebral artery (MCA) is not depicted, and a plexiform arterial network is formed—is similar to the findings of Moyamoya disease. Here, we describe a 78-year-old man who presented with mild right paralysis and aphasia. Magnetic resonance angiography (MRA) at admission did not show the bilateral MCAs. The findings were similar to those of Moyamoya disease, and his symptoms worsened after hospitalization. Endovascular treatment was performed, and the left MCA was completely recanalized. Later, paroxysmal atrial fibrillation was detected, and we finally determined that left MCA occlusion had occurred due to embolism. The right MCA was completely occluded at its origin, indicating an Ap/T-MCA. Embolic occlusion of the unilateral MCA and contralateral Ap/T-MCA made this case resemble Moyamoya disease in the acute stage. Even when chronic occlusion is suspected on MRA in acute cerebral infarction, endovascular treatment should be considered. Additionally, a heterotypic R4810K polymorphism was later found in the RNF213 gene. To our knowledge, this is the second report of Ap/T-MCA with the RNF213 gene polymorphism; however, their association remains unclear and requires further analyses.

scholarly journals Coincident craniopharyngioma and unruptured aneurysm at the right M1- M2 segment of the middle cerebral artery. Case report 1

2019 ◽  
Vol 29 (01) ◽  
pp. 35-39
Author(s):  
Williams Escalante ◽  
Denis Isao Ueoka ◽  
Eduardo Andre Goulart de Alcântara ◽  
Anderson Rodrigo de Sousa ◽  
Paulo Henrique Pires de Aguiar ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Unruptured Aneurysm ◽  
Vascular Lesions ◽  
Resonance Imaging ◽  
Surgical Time ◽  
Appropriate Treatment ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

We report a case of coincident craniopharyngioma with an unruptured aneurysm at the right M1- M2 segment of the middle cerebral artery; and discuss the surgical approach to two different pathologies treated at same surgical time, as well as current theories to explain the coincidence or association between tumor and vascular lesions at the sellar and suprasellar regions. The patient was a 59-year-old woman; with a history of visual impairment and headache. Both lesions were identified by magnetic resonance imaging (MRI) and cerebral angiography, and were treated surgically. We suggest individualized treatment for each case, choosing the best neurosurgical approach to achieve an appropriate treatment of both pathologies in the same operative session.

Prolonged/delayed cerebral hyperperfusion in adult patients with moyamoya disease with RNF213 gene polymorphism c.14576G>A (rs112735431) after superficial temporal artery–middle cerebral artery anastomosis

2020 ◽  
pp. 1-8
Author(s):  
Ryosuke Tashiro ◽  
Miki Fujimura ◽  
Masahito Katsuki ◽  
Taketo Nishizawa ◽  
Yasutake Tomata ◽  
...  
Keyword(s):  
Genetic Analysis ◽  
Gene Polymorphism ◽  
Intracerebral Hemorrhage ◽  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Adult Patients ◽  
Cerebral Hyperperfusion

OBJECTIVESuperficial temporal artery–middle cerebral artery (STA-MCA) anastomosis is the standard surgical management for moyamoya disease (MMD), whereas cerebral hyperperfusion (CHP) is one of the potential complications of this procedure that can result in delayed intracerebral hemorrhage and/or neurological deterioration. Recent advances in perioperative management in the early postoperative period have significantly reduced the risk of CHP syndrome, but delayed intracerebral hemorrhage and prolonged/delayed CHP are still major clinical issues. The clinical implication of RNF213 gene polymorphism c.14576G>A (rs112735431), a susceptibility variant for MMD, includes early disease onset and a more severe form of MMD, but its significance in perioperative pathology is unknown. Thus, the authors investigated the role of RNF213 polymorphism in perioperative hemodynamics after STA-MCA anastomosis for MMD.METHODSAmong 96 consecutive adult patients with MMD comprising 105 hemispheres who underwent serial quantitative cerebral blood flow (CBF) analysis by N-isopropyl-p-[123I]iodoamphetamine SPECT after STA-MCA anastomosis, 66 patients consented to genetic analysis of RNF213. Patients were routinely maintained under strict blood pressure control during and after surgery. The local CBF values were quantified at the vascular territory supplied by the bypass on postoperative days (PODs) 1 and 7. The authors defined the radiological CHP phenomenon as a local CBF increase of more than 150% compared with the preoperative values, and then they investigated the correlation between RNF213 polymorphism and the development of CHP.RESULTSCHP at POD 1 was observed in 23 hemispheres (23/73 hemispheres [31.5%]), and its incidence was not statistically different between groups (15/41 [36.6%] in RNF213-mutant group vs 8/32 [25.0%] in RNF213–wild type (WT) group; p = 0.321). CHP on POD 7, which is a relatively late period of the CHP phenomenon in MMD, was evident in 9 patients (9/73 hemispheres [12.3%]) after STA-MCA anastomosis. This prolonged/delayed CHP was exclusively observed in the RNF213-mutant group (9/41 [22.0%] in the RNF213-mutant group vs 0/32 [0.0%] in the RNF213-WT group; p = 0.004). Multivariate analysis revealed that RNF213 polymorphism was significantly associated with CBF increase on POD 7 (OR 5.47, 95% CI 1.06–28.35; p = 0.043).CONCLUSIONSProlonged/delayed CHP after revascularization surgery was exclusively found in the RNF213-mutant group. Although the exact mechanism underlying the contribution of RNF213 polymorphism to the prolonged/delayed CBF increase in patients with MMD is unclear, the current study suggests that genetic analysis of RNF213 is useful for predicting the perioperative pathology of patients with MMD.

Embolization of a Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Report

Neurosurgery ◽  
1983 ◽  
Vol 12 (3) ◽  
pp. 342-345 ◽  
Author(s):  
Frances K. Conley
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Bilateral Carotid ◽  
History Of ◽  
Internal Carotid Arteries ◽  
Bilateral Carotid Artery

Abstract This case history of a man with bilateral carotid artery occlusions presents angiographic documentation of the embolization of a superficial temporal-middle cerebral artery bypass. The embolic source was thrombotic and/or atheromatous debris that had collected in the persistent stump of one of the occluded internal carotid arteries.

Republished: Successful treatment of ruptured multiple fusiform middle cerebral artery aneurysms with silk vista baby flow diverter in a 10-months-old infant

2021 ◽  
pp. neurintsurg-2021-017554.rep
Author(s):  
Giovanni Barchetti ◽  
Loris Di Clemente ◽  
Mauro Mazzetto ◽  
Mariano Zanusso ◽  
Paola Ferrarese ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Successful Treatment ◽  
Expectant Management ◽  
Flow Diverter ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Microsurgical Clipping ◽  
Parent Artery Occlusion ◽  
The Right

We report the successful treatment of multiple ruptured fusiform middle cerebral artery (MCA) aneurysms in a 10-month-old girl. This previously healthy infant presented with subarachnoid haemorrhage and was found to have multiple irregular dilatations of the superior division branch of the right MCA. Cerebral angiography was performed and confirmed the presence of multiple fusiform aneurysms of the MCA. After multidisciplinary team discussion, it was decided to treat the aneurysms with endovascular approach, using a flow-diverter. Microsurgical clipping was deemed risky because of the high likelihood of parent artery occlusion and expectant management was also considered inappropriate because of the risk of re-bleeding. Dual antiplatelet therapy was started, and a flow-diverter was successfully delivered in the superior division branch of the right MCA. The post-operative course was uneventful, MRI at 12 months did not show any sign of recurrence and at 3 years of age the patient had a normal neurological examination.

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