Paradoxical symptomatic cerebral blood flow decreases after combined revascularization surgery for patients with pediatric moyamoya disease: illustrative case

BACKGROUND Transient neurological deficits (TNDs) develop after cerebral revascularization in patients with moyamoya disease (MMD). The authors report a rare pediatric MMD case with extensive decreased cerebral blood flow (CBF) and prolonged TNDs after combined revascularization. OBSERVATIONS A 9-year-old boy presented with transient left upper limb weakness, and MMD was diagnosed. A right-sided combined surgery was performed. Two years after the surgery, frequent but transient facial (right-sided) and upper limb weakness appeared. The left internal carotid artery terminal stenosis had progressed. Therefore, a left combined revascularization was performed. The patient’s motor aphasia and right upper limb weakness persisted for approximately 10 days after surgery. Magnetic resonance angiography showed that the direct bypass was patent, but extensive decreases in left CBF were observed using single photon emission tomography. With adequate fluid therapy and blood pressure control, the neurological symptoms eventually disappeared, and CBF improved. LESSONS The environment of cerebral hemodynamics is heterogeneous after cerebral revascularization for MMD, and the exact mechanism of CBF decreases was not identified. TNDs are significantly associated with the onset of stroke during the early postoperative period. Therefore, appropriate treatment is desired after determining complex cerebral hemodynamics using CBF studies.

Еffects of percutaneous electrical stimulation of the spinal cord in combination with mechanotherapy on changes in systemic and regional hemodynamics

Objective: to evaluate changes in systemic and cerebral hemodynamics during percutaneous electrical stimulation of the spinal cord and in combination of electrical stimulation with mechanotherapy. Methodology. The subjects underwent percutaneous electrical stimulation of the spinal cord, the duration of the session was 5 minutes. Mechanotherapy was performed using a treadmill. The subjects performed walking at a power of 25W. for 5 minutes. Hemodynamics was evaluated before and after the electrical stimulation session, as well as before and after the mechanical therapy session on the track in combination with percutaneous electrical stimulation of the spinal cord. To study systemic and regional hemodynamics, a rheograph-polyanalyzer "REAN-POLY" was used. Results. Electrical stimulation of the spinal cord does not lead to significant changes in systemic and cerebral hemodynamics. Percutaneous electrical stimulation of the spinal cord in combination with physical exertion leads to reactive changes in systemic hemodynamics, increased blood filling and venous outflow, against the background of a decrease in peripheral resistance of cerebral vessels. Key words: electrostimulation, percutaneous electrostimulation, mechanotherapy, systemic hemodynamics, regional hemodynamics.