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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Moyamoya disease is a rare but well described entity which has been found in the angiographic investigation of subarachnoid hemorrhage, its most common symptom in adults. We present 4 patients in whom moyamoya disease and an intracranial saccular aneurysm were discovered. In 2 of the 3 patients suffering a hemorrhage, the aneurysm was the source of bleeding. Three of the aneurysms were located at the basilar artery bifurcation. We recommend a careful search for a concomitant aneurysm in all patients with subarachnoid hemorrhage in whom moyamoya disease is found. We believe these patients should be treated as though the aneurysm were the source of bleeding.
Stroke
PMID:Intracranial saccular aneurysm and moyamoya disease. 44 41

This report concerns a hypertensive woman who suffered a stroke at the age of 51 and recovered from left hemiparesis after 3 to 4 months. During the subsequent 24 years she had four seizures which involved the left arm and face and became generalized, ending with left hemiparesis, from which she recovered after 4 to 5 days. Carotid angiography was performed in 1967, 1973 and 1974 and the characteristic picture of moyamoya disease was demonstrated. She died at the age of 77 with extensive vascular disease. The literature concerning 215 cases of moyamoya disease, in which there were 14 intracerebral hematomas, is reviewed and discussed.
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PMID:Moyamoya disease and intracerebral hematoma. Clinical pathological report. 51 96

An opportunity to study cerebrovascular changes in sickle cell anemia (SCA) presented itself when a black child with this disorder died of bihemispheric strokes. Angiography demonstrated severe occlusive vascular disease involving primarily the circle of Willis and major bifurcations of both internal carotid arteries. Collateral circulation to the distal branches of the internal carotid arteries occurred through transdural anastomoses from the external carotid system and via the leptomeningeal route. Perfusion of the basal ganglia was accomplished by vessels arising from the proximal internal carotid arteries. These changes resembled those of Moyamoya disease. Autopsy showed old and recent cerebral infarcts. Two vascular processes were responsible for the arterial occlusions: (1) exuberant intimal hyperplasia, and (2) old and recent thrombi with partial recanalization. The former has been described only once before in SCA. Small vessels in the basal ganglia were exceptionally numerous and dilated. We conclude that intimal hyperplasia within large cerebral arteries may be responsible for infarction and small vessel prliferation in basal ganglia in patients with SCA.
Stroke
PMID:Cerebrovascular disease in sickle cell anemia: a clinical, pathological and radiological correlation. 62 45

A review of the recent Mayo Clinic experience with stroke in children having cerebral angiography revealed five patients with moyamoya disease. The disease commonly presents as recurrent strokes and only rarely as a seizure disorder. The angiographic pattern suggests that the telangiectasia characteristic of this condition represents normally present dilated vessels.
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PMID:Moyamoya disease in children. 62 48

A 16-year-old boy, who had sudden left-sided hemiplegia, died two weeks following onset of symptoms. A right carotid angiogram showed stenosis at the termination of the internal carotid artery. The middle cerebral artery had a beaded appearance and some of its branches were occluded. A basal "moyamoya" syndrome and transdural anastomoses were present. At autopsy, multiple intracranial dissecting aneurysms were found. Arteries of the body displayed fibromuscular dysplasia (FMD). The relevance of dysplastic changes of intracranial arteries and the relationship to moyamoya syndrome are discussed.
Stroke
PMID:Fibromuscular dysplasia and multiple dissecting aneurysms of intracranial arteries. A further cause of Moyamoya syndrome. 96 Jan 59

Bypass surgery is a safe procedure with low mortality and morbidity, and few reported surgical complications. Three patients developed postoperative chronic subdural hematoma (CSDH): two with stroke after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and one with moyamoya disease after STA-MCA anastomosis combined with encephalomyosynangiosis. The factors inducing CSDH after revascularization in the seven reported and present cases included postoperative subdural effusion associated with brain atrophy, and postoperative anticoagulant therapy such as aspirin. CSDH may occur in patients with pre-existing brain atrophy and postoperative subdural effusion. Anticoagulant therapy should be avoided at the early postoperative stage after bypass surgery.
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PMID:Chronic subdural hematoma following bypass surgery--report of three cases. 138 57

Middle cerebral artery obstruction in children is reviewed by our two cases. Ischemic childhood stroke was caused by moyamoya disease in the first, and by fibromuscular dysplasia in the second patient. In both cases transcranial Doppler sonography and cranial CT were performed, but the final diagnosis was made by angiography. The importance of angiography in childhood stroke is emphasized.
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PMID:Obstruction of cerebral arteries in childhood stroke. 140 55

Between May, 1974, and March, 1991, 104 patients with moyamoya disease, all under 16 years old at the time of first surgery, underwent superficial temporal-to-middle cerebral artery anastomosis and/or encephalomyosynangiosis. The mean follow-up period was 9.6 years (range 4.8 to 16.0 years). Hemiplegia was the most frequent symptom before the first operation. Transient ischemic attacks (TIA's) were noted in 57 patients and minor stroke with hemiplegia in 44. The most frequent type of cortical dysfunction was aphasia (21 cases). Postoperatively, the incidence of TIA's and/or completed stroke with motor weakness of the extremities was markedly decreased, but visual disturbance progressed and major or minor stroke with visual disturbance was found in two cases. In patients under the age of 3 years, a major stroke prior to surgery resulted in a poor outcome in 36% of cases. Preoperative major stroke in patients between the ages of 3 and 7 years was less frequent, and poor outcomes were seen in 17% of this group. There were no major preoperative strokes in patients with surgery after the age of 7 years, and no poor outcomes were recorded in this group. A major preoperative stroke prior to surgery had adverse impact on the ultimate patient intelligence quotient (IQ) following surgery. All patients operated on after the age of 7 years had a normal or borderline IQ at follow-up examination.
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PMID:Long-term follow-up study after extracranial-intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease. 160 76

We have performed 10 bypass operations on 7 adult patients with moyamoya disease over the past 6 years. Four had haemorrhagic episodes and three had ischemic episodes. Three patients underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass on both sides and the other four had the procedure on one side. Six of 7 patients showed angiographical improvement after the bypass operation while one patient did not. This patient underwent the second severe stroke and became vegetative during the course of follow-up. Another patient died of myocardial infarction during the follow-up time. Five patients are capable of carrying out their original work. Considerations regarding the cause, operative methods and disease course in the patients are discussed.
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PMID:EC-IC bypass for adult patients with moyamoya disease. 168 37

5 cases of ischemic strokes in young women who used oral contraceptives and smoked cigarettes are described in clinical and angiographic detail, the risk factors for moyamoya disease are discussed in a review or strokes in pill users, and the notion that oral contraceptive and smoking may cause a moyamoya pattern of stroke is proposed. The women were aged 20-32, used the pill from 2 weeks-8 years, had smoked approximately 10-20 pack-years. 2 women had headaches and 4 had transient ischemic attacks before their multifocal symptoms in visual, somatosensory and motor function, language, speech and cognition. 2 had seizures. Angiographic patterns of either supraclinoid stenosis (4) or proximal carotid artery stenosis (1) with the collateral circulation characteristic of moyamoya disease were evident in all, but there was no evidence of hemorrhagic infarction. There were no signs of atherosclerosis. Subtle signs of an immunologic process included antinuclear antibody titer of 1:160 in 1 woman, elevated sedimentation rate and elevated circulating immune complexes in another patient, and elevated cerebrospinal protein and IgG in a third woman. 4 of the patients remained stable after stopping oral contraceptives and stopping or reducing smoking. The 5th, who continued smoking, had progressive symptoms for 10 years. It was suggested that antibodies to ethinyl estradiol, a possible cause of this disorder, be further investigated.
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PMID:Accelerated intracranial occlusive disease, oral contraceptives, and cigarette use. 841 56


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