A Case of Moyamoya Vasculopathy Presenting as Simultaneous Ischemic and Hemorrhagic Strokes.

IF 0.9 Q4 CLINICAL NEUROLOGY
Wayne Zhong, Amit Mehta, Nicholas Haberli, Ahmed Elmashad, Rachel Forman, Jennifer Kim
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Abstract

Background: Moyamoya disease (MMD) is a rare pathological state characterized by progressive stenosis of the terminal portion of the internal carotid arteries (ICA). Complications include both ischemic and hemorrhagic strokes, for which there is no curative treatment for MMD. Early diagnosis with surgical intervention is vital for there is no definitive treatment. Due to the bimodal age distribution, moyamoya should be considered for patients presenting with stroke and supraclinoid ICA vasculopathy.

Case: We present a case of a 23-year-old female who presented with left arm weakness and sudden onset thunderclap headache. Upon further questioning, it was revealed that the patient had started an estrogen-containing birth control two weeks prior to presentation. Neuroimaging at our tertiary care center demonstrated simultaneous ischemic and hemorrhagic strokes in the bilateral hemispheres associated with vasculopathy seen in both invasive and noninvasive cerebrovascular imaging. She was diagnosed with idiopathic moyamoya disease since her serum and cerebrospinal fluid studies did not reveal any obvious precipitators to suggest moyamoya syndrome (MMS).

Conclusion: There were no obvious precipitating factors identified in the extensive workup for this patient. Therefore, further secondary prevention is difficult for this otherwise young and healthy individual. While there is data to support the use of antiplatelet medications for the prevention of ischemic stroke secondary to intracranial atherosclerotic disease, there are no clear guidelines for the treatment of MMD that simultaneously causes ischemic and hemorrhagic stroke. Further research on the pathophysiology and treatment modalities for MMD are needed to guide clinicians in treating this complex disease.

一例同时表现为缺血性和出血性脑卒中的莫亚莫亚血管病病例
背景:莫亚莫亚病(MMD)是一种罕见的病理状态,其特征是颈内动脉(ICA)末端部分进行性狭窄。并发症包括缺血性和出血性脑卒中,目前尚无根治方法。由于没有确切的治疗方法,早期诊断和手术干预至关重要。由于患者的年龄呈双峰分布,因此,对于出现中风和环上ICA血管病变的患者,应考虑为moyamoya:病例:我们接诊了一例 23 岁女性患者,她出现左臂无力和突发性雷击样头痛。进一步询问得知,患者在发病前两周开始服用含雌激素的避孕药。在我们的三级医疗中心进行的神经影像学检查显示,双侧大脑半球同时出现缺血性和出血性中风,有创和无创脑血管影像学检查均显示存在血管病变。她被诊断为特发性莫亚莫亚病,因为她的血清和脑脊液检查没有发现任何明显的诱发因素,提示她患有莫亚莫亚综合征(MMS):结论:在对该患者进行的大量检查中,没有发现明显的诱发因素。因此,对于这名年轻而健康的患者来说,很难进一步进行二级预防。虽然有数据支持使用抗血小板药物预防继发于颅内动脉粥样硬化疾病的缺血性中风,但对于同时导致缺血性和出血性中风的马里亚纳综合征,目前还没有明确的治疗指南。需要进一步研究 MMD 的病理生理学和治疗方法,以指导临床医生治疗这种复杂的疾病。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurohospitalist
Neurohospitalist CLINICAL NEUROLOGY-
CiteScore
1.60
自引率
0.00%
发文量
108
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