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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). Seizure is known as a rare complication after revascularization for moyamoya disease, although its underlying mechanism is undetermined. We investigated the relationship between seizure attack and postoperative alteration in CBF in patients with moyamoya disease. CBF was routinely measured by N-isopropyl-p-[123I] iodpamphetamine (123I-IMP-SPECT) 1 and 7 days after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis on 64 sides of the 44 consecutive patients (male:female = 13:31, 2-62 years old) with moyamoya disease. Three patients (male:female = 1:2, 40-55 years old) suffered from seizure attack at 1 to 10 days after surgery. Two of the three patients manifested as seizures at 8-10 days after surgery and presented transient neurologic deteriolation before seizure. Postoperative SPECT revealed significant increase in CBF at the sites of the anastomosis in all three patients. Postoperative magnetic resonance imaging showed no ischemic changes, and magnetic resonance angiography showed the apparently patent STA-MCA anastomosis as thick high signal intensity sign in all three patients. The anatomical location and the temporal profile of hyperperfusion were completely in accordance with the focus of seizure attack. Intensive blood pressure control and the use of antiepileptic agents were instituted. The neurologic deficits were resolved and no seizure attack recurred in three patients. Seizure following STA-MCA anastomosis can be caused by hyperperfusion in patients with moyamoya disease. When seizure attacks occur, routine CBF measurement is recommended to differentiate hyperperfusion and ischemia, since the treatments for these conditions are contradictory.
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PMID:[Seizure following superficial temporal-middle cerebral artery anastomosis in patients with moyamoya disease: possible contribution of postoperative cerebral hyperperfusion]. 1749 42

A 56-year-old woman with moyamoya disease presented with angina pectoris. Coronary artery stenosis of atherosclerosis origin was resistant to repeated transluminal angioplasty. Coronary artery bypass grafting was performed by minimal invasive direct coronary artery bypass (MIDCAB), avoiding cardiopulmonary bypass and intraoperative hypotension. Since coronary artery bypass grafting on cardiopulmonary bypass for patients with moyamoya disease has a potential risk of brain ischemia, MIDCAB may avoid perioperative cerebral ischemic complication.
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PMID:Minimal invasive direct coronary artery bypass in moyamoya disease. 1766 90

Moyamoya disease is an occlusive intracranial arteriopathy owing to intimal hyperplasia with formation of abnormal cerebrovascular collateral networks; however, the etiology remains unclear. Although this disease is known to be associated with renovascular hypertension, it is extremely rare for it to be associated with stenoses of the coronary arteries. We herein described a case of a 56-year-old female with angina and asymptomatic moyamoya disease. We performed off-pump coronary artery bypass grafting (OPCAB) to avoid cardiopulmonary bypass and the risk of intraoperative hypotension. Conventional coronary artery bypass grafting has a potential risk of brain ischemia in moyamoya patients, but OPCAB may avoid this perioperative cerebral ischemic complication.
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PMID:Off-pump coronary artery bypass grafting in moyamoya disease. 1796 49

This article extensively reviews the history, indications for bypass, choice of grafts, techniques, complications, and results after cerebral revascularization. The current role and future perspectives of cerebral revascularization are discussed. The results of 295 direct revascularization procedures in 285 patients (130 tumors and 115 aneurysms from 1988 to 2006; 40 cases of ischemia from 1994 to 2006) and 26 pial synangiosis procedures (for moyamoya syndrome in children from 1997 to 2007) have been summarized. Current operative techniques are illustrated with drawings and video clips.
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PMID:Cerebral revascularization for ischemia, aneurysms, and cranial base tumors. 1869 58

The authors describe their minimally invasive technique for performing a superficial temporal artery (STA) to middle cerebral artery (MCA) bypass, which relies on an enlarged bur hole (2-2.5 cm) rather than the standard craniotomy. They perform this procedure in a minimally invasive fashion, using CT angiography for intraoperative neuronavigation as well as for preoperative identification of the donor and recipient vessels and planning of bur hole location. They present 2 cases in which this procedure was used, including one involving a patient with multivessel occlusive disease and significant cerebrovascular hemodynamic compromise in whom they performed the procedure using only local anesthetic and propofol sedation in order to minimize the risk of hypotension associated with the use of general anesthetic agents. A comprehensive literature search revealed no previously published case of an extracranial-intracranial arterial bypass procedure performed in an awake patient. The authors have adopted the described minimally invasive method for all STA-MCA bypass procedures. The awake setting, however, is reserved for specific indications, primarily patients with severe moyamoya disease, in whom ventilator-related hypocarbia can result in intraoperative ischemia, or patients with multivessel occlusive disease and significant cerebral hemodynamic compromise, in whom general anesthesia-related hypotension can lead to intraoperative ischemia.
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PMID:Minimally invasive superficial temporal artery to middle cerebral artery bypass through an enlarged bur hole: the use of computed tomography angiography neuronavigation in surgical planning. 1875 90

The authors present a rare case of an infarction complication 15 days following acute intraventricular bleeding due to moyamoya disease. Before the infarction occurred, perfusion CT imaging disclosed early but reversible ischemic injury on the day of hemorrhage. Dehydration and hypotension are both possibly contributing factors of progressive injury from reversible ischemia due to infarction. Although the patient underwent successful bypass surgery, 1 month after the ictus the neurobehavior evaluation still showed marked executive dysfunction. The authors address that, in hemorrhagic-type moyamoya disease, early perfusion CT scanning is not only a powerful tool to identify the high-risk group of patients who could experience subacute infarction, but also alarms neurosurgeons to eliminate any predisposing factors when it shows reversible ischemic injuries.
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PMID:Acute cerebral ischemia following intraventricular hemorrhage in moyamoya disease: early perfusion computed tomography findings. 1903 18

Moyamoya, meaning a "hazy puff of smoke" in Japanese, is a chronic, occlusive cerebrovascular disease involving bilateral stenosis or occlusion of the terminal portion of the internal carotid arteries (ICAs) and/or the proximal portions of the anterior cerebral arteries and middle cerebral arteries (MCAs). The Ministry of Health and Welfare of Japan has defined 4 types of moyamoya disease (MMD): ischemic, hemorrhagic, epileptic, and "other." The ischemic type has been shown to predominate in childhood, while the hemorrhagic type is more often observed in the adult population. The highest prevalence of MMD is found in Japan, with a higher female to male ratio. Studies have shown a possible genetic association of MMD linked to chromosome 17 in Japanese cases as well as in cases found in other demographics. During autopsy, intracerebral hematoma is found and most commonly serves as the major cause of death in patients with MMD. Moyamoya vessels at the base of the brain are composed of medium-sized or small muscular arteries emanating from the circle of Willis, mainly the intracranial portions of ICAs, anterior choroidal arteries, and posterior cerebral arteries, forming complex channels that connect with distal positions of the MCAs. Off of these channels are small tortuous and dilated vessels that penetrate into the base of the brain at the site of the thalamoperforate and lenticulostriate arteries. On angiography, there is the characteristic stenosis or occlusion bilaterally at the terminal portion of the ICAs as well as the moyamoya vessels at the base of the brain. Six angiographic stages have been described, from Stage 1, which reveals a narrowing of the carotid forks, to Stage 6, in which the moyamoya vessels disappear and collateral circulation is produced solely from the external carotid arteries. Cases with milder symptoms are usually treated conservatively; however, more severe symptomatic cases are treated using revascularization procedures. Surgical treatments are divided into 3 types: direct, indirect, and combined/other methods. Direct bypass includes superficial temporal artery-MCA bypass or use of other graft types. Indirect procedures bring in circulation to the intracranial regions by introducing newly developed vasculature from newly approximated tissues. These procedures may not be enough to prevent further ischemia; therefore, a combination of direct and indirect procedures is more suitable. This article will give a review of the epidemiology, natural history, pathology, pathophysiology, and diagnostic criteria, including imaging, and briefly describe the surgical treatment of MMD.
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PMID:Moyamoya disease: a summary. 1933 27

We analyzed the records of 44 patients with moyamoya disease evaluated and treated at our Institute from 1998 until 2007. Out of 44 patients, 18 (41%) were in the paediatric age group and 26 (59%) were adults. Presentation was ischemic in 14 (32%) and hemorrhagic in 30 patients (68%). Revascularization was performed in 11 patients (five patients with ischemic presentation and six with hemorrhagic presentation): nine patients underwent indirect revascularization procedures only and two patients underwent indirect revascularization procedures and a combined superficial temporal artery-middle cerebral artery bypass. Thirty-six patients (81.8%) were available for follow-up. Out of 11 patients who underwent revascularization procedures, none had further hemorrhagic or ischemic episodes. Out of the 19 conservatively managed patients who were followed-up, seven (36.8%) developed new episodes of ischemia (n=2) or hemorrhage (n=5). In-hospital mortality was 6.8% (three patients), all of whom were in the hemorrhagic presentation group.
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PMID:Ten-year experience of 44 patients with moyamoya disease from a single institution. 2018 93

Aim of the study was to demonstrate the possibility of effective surgical revascularization of the brain in children with moya-moya disease. 3 year old girl with moya-moya disease underwent encephalo-duro-arteriosynangiosis. At 14 months follow-up signs and symptoms of cerebral ischemia totally resolved. Angiography confirmed brain supply from external carotid artery via the newly formed anastomotic network. Authors emphasize the necessity to seek moyamoya disease in children with symptoms of brain ischemia to allow timely and effective surgical treatment.
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PMID:[Successful treatment of moya-moya disease using encephalo-duro-arteriosynangiosis]. 2042 66

Intraventricular hemorrhage during pregnancy is usually followed by a poor recovery. When caused by moyamoya disease, ischemic or hemorrhagic episodes may complicate the management of high intracranial pressure. A 26-year-old Caucasian woman presented with generalized seizures and a Glasgow Coma Score (GCS) of 3 during the 36th week of pregnancy. The fetus was delivered by caesarean section. The brain CT in the mother revealed bilateral intraventricular hemorrhage, a callosal hematoma, hydrocephalus and right frontal ischemia. Refractory high intracranial pressure developed and required bilateral ventricular drainage and intensive care treatment with barbiturates and hypothermia. Magnetic resonance imaging and cerebral angiography revealed a moyamoya syndrome with rupture of the abnormal collateral vascular network as the cause of the hemorrhage. Intracranial pressure could only be controlled after the surgical removal of the clots after a large opening of the right ventricle. Despite an initially low GCS, this patient made a good functional recovery at one year follow-up. Management of refractory high intracranial pressure following moyamoya related intraventricular bleeding should require optimal removal of ventricular clots and appropriate control of cerebral hemodynamics to avoid ischemic or hemorrhagic complications.
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PMID:Refractory High Intracranial Pressure following Intraventricular Hemorrhage due to Moyamoya Disease in a Pregnant Caucasian Woman. 2050 23


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