Case Report: A rare presentation of rapidly progressive moyamoya disease refractory to unilateral surgical revascularization

被引:0
|
作者
Leach, Daniel Friel [1 ]
Margam, Srivikram [2 ]
Gustin, Aaron [3 ]
Gustin, Paul J. [3 ]
Jajeh, Mohamad N. [4 ]
Chavis, Yhana C. [1 ]
Walker, Kristin V. [1 ]
Bentley, Joshua S. [5 ]
机构
[1] Univ Virginia Hlth, Dept Radiat Oncol, Charlottesville, VA 22903 USA
[2] Alabama Coll Osteopath Med, Res, Dothan, AL USA
[3] Carle BroMenn Med Ctr, Neurol Surg, Normal, IL 61761 USA
[4] Southeast Hlth, Internal Med, Dothan, AL USA
[5] Southeast Hlth, Cerebrovasc & Endovasc Neurosurg, Dothan, AL 36301 USA
来源
FRONTIERS IN SURGERY | 2024年 / 11卷
关键词
moyamoya disease; ischemic stroke; cervicocerebral catheter angiography; pre-operative Suzuki angiography staging; surgical revascularization; post-operative Matsushima grade; MIDDLE CEREBRAL-ARTERIES; CLINICAL-FEATURES; EMBOLIZATION; ANEURYSMS; BYPASS;
D O I
10.3389/fsurg.2024.1409692
中图分类号
R61 [外科手术学];
学科分类号
摘要
Moyamoya disease (MMD) is a chronic, occlusive cerebrovasculopathy typified by progressive steno-occlusive disease of the intracranial internal carotid arteries (ICAs) and their proximal branches. Moyamoya syndrome (MMS) categorizes patients with characteristic MMD plus associated conditions. As such, the most usual presentations are those that occur with cerebral ischemia, specifically transient ischemic attack, acute ischemic stroke, and seizures. Hemorrhagic stroke, headaches, and migraines can also occur secondary to the compensatory growth of fragile collateral vessels propagated by chronic cerebral ischemia. While the pathophysiology of MMD is unknown, there remain numerous clinical associations including radiation therapy to the brain, inherited genetic syndromes, hematologic disorders, and autoimmune conditions. We describe the case of a 31-year-old woman who presented with recurrent ischemic cerebral infarcts secondary to rapidly progressive, bilateral MMD despite undergoing early unilateral surgical revascularization with direct arterial bypass. She had numerous metabolic conditions and rapidly decompensated, ultimately passing away despite intensive and aggressive interventions. The present case highlights that progression of moyamoya disease to bilateral involvement can occur very rapidly, within a mere 6 weeks, a phenomenon which has not been documented in the literature to our knowledge.
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页数:7
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