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

In children with Moyamoya disease, transient ischemic attacks often occur during hyperventilation, and the frequency of attacks usually decreases with advancing age. To elucidate the mechanism of the attacks, the regional cerebral blood flow was measured during rest and/or hyperventilation in children aged 3-16 with Moyamoya disease. Regional cerebral blood flow during rest was significantly higher in younger children with Moyamoya disease, and it progressively decreased with advancing age through childhood. During hyperventilation, regional cerebral blood flow decreased in all the children, although blood flow in younger children was still higher than that in the older children. Nevertheless, transient ischemic attacks were more readily precipitated by hyperventilation in the younger than in the older children. Cerebral metabolic demand is much higher in the first decade of life than in later decades. Therefore, it seems likely that even a moderate reduction in cerebral blood flow can cause metabolic impairment in young children. Such high cerebral metabolic demand may play an important role in the frequent occurrence of transient ischemic attacks in young children with Moyamoya disease.
Stroke
PMID:Regional cerebral blood flow, clinical manifestations, and age in children with moyamoya disease. 362 50

Cerebrovascular disorders in children is a rare clinical entity, epidemiologic studies of which are very scarce in Japan. Hence this study analyzed 13,131 sick children admitted to Children's General Hospital in light of the incidence of cerebrovascular accident in children and its specific characteristics. In this paper, the cases of cerebral infarct are analyzed with special reference to their developmental outcomes. The results show that one hundred twenty children (0.85 percent of all sick children) had cerebrovascular disorders documented both in clinical pictures and CT scans. This number accounted for 2.5% of 4,738 CT examinations performed for these sick children. There were 79 cases of intracranial hemorrhage, 24 of cerebral infarction and 17 of vascular anomalies, 65.8%, 20.0% and 14.2% respectively. In the intracranial hemorrhage group, there was a different pathophysiology in each age group. The fact that intraventricular hemorrhage occurred in premature neonates, subarachnoid or posterior fossa subdural hemorrhage in mature neonates and infants, and intracerebral hematoma in elder children due to different causes was very striking. In the cerebral infarct group, the middle cerebral artery was most commonly affected (11 out of 24 cases); others had various lesions such as lacunar stroke, internal carotid artery occlusion and so on. The most impressive but disappointing fact in those children was that their clinical pictures were quite miserable, revealing low IQs. Nine out of 24 children with cerebral infarct had IQs below 20. In the abnormal vessels group, there were Moyamoya disease, arteriovenous malformation, intracranial aneurysm, Sturge-Weber syndrome, Menkes disease and coiling of the internal carotid or vertebral arteries each demonstrating unique angiographic findings.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Incidence and characteristics of cerebrovascular disorders in children--critical analysis of 120 cases experienced at a children's general hospital]. 370 14

Moyamoya disease presents clinically as chronic progressive ischemia in the young brain. The brain is surrounded by concentric collateral networks but all of these networks are not available as collaterals in the early stage of cerebral ischemia. The anatomical characteristics precluding their early use include the presence of the watery layer of subarachnoid fluid between the cortical and dural vessels and of a closed bony box intervening between the dural and scalp arterial networks. These barriers isolate the brain from the abundant blood flow of the external carotid system as if they were the moat (the subarachnoid fluid layer) and the walls (the skull) of a castle. Based on these concepts, we have developed a surgical procedure, the encephalo-duro-arterio-synangiosis to treat moyamoya disease in children. This operation surmounts the above mentioned two obstacles to collateral formation to the brain by perforating the castle wall and bridging the moat by granulation tissue, without injuring the collaterals which are already formed. This procedure was performed on 70 sides in 38 pediatric moyamoya patients. Revascularisation of the brain was obtained in 100 percent of the cases with varying improvement in the symptoms.
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PMID:The specificity of the collaterals to the brain through the study and surgical treatment of moyamoya disease. 394 75

We have reported the characteristic dynamic changes at the base of the brain in childhood Moyamoya disease in terms of follow-up angiography. So we have classified the angiographical findings of Moyamoya disease into six stages. However, there have been no report that proved these findings in long-term follow-up. On the other hand, these angiographical findings are mainly observed in children, we can seldom to find out any changes in adults. We performed long-term follow up angiography in adult cases whose onset was in childhood to clarify the natural course of this disease and to understand the difference between the cases of children and adults. Eleven cases (4 males and 7 females) of Moyamoya disease were investigated by angiography. Average onset was 5.1 years old. All of them were diagnosed by initial angiography in childhood (average age were 6.5 years old) and they grew up into adolescence (average age were 18.6 years old) at the time of follow-up study. Initial symptoms of them were all ischemic (TIA 7, RIND 2 or completed stroke 2). The symptoms at the time of follow-up were mental retardation in 5 patients, slight neurological deficits in 1, TIA in 2 and normal in 3. Among them, one patient had suffered from intraventricular hemorrhage. The results were as follows: the progression of angiographical stages was observed in 95% of sides. In 71% of sides, angiographical stage was in 5 or 6 which is thought to be an end stage of this disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Long-term follow-up angiography of moyamoya disease--cases followed from childhood to adolescence]. 395 60

Seventeen patients with basal occlusive disease have been seen over the past 4 years. Nine of these had a classical moyamoya appearance on angiography. Of these nine, seven were adults and two were children. Eight had ischemic episodes, and one had a hemorrhage. One had neurofibromatosis with a chiasmal glioma and had received radiotherapy. Eight patients underwent superficial temporal-middle cerebral artery (STA-MCA) bypass, and one refused operation. Six patients improved, one had a stroke on the opposite side, and one died. Eight patients had unilateral basal arterial occlusive disease. Of these, three had ischemic episodes, four had hemorrhages, and one had only headaches. Four were adults, and four were children. Five underwent STA-MCA bypass with improvement, one with headaches had an aneurysm treated, and two were not operated upon. Considerations regarding the cause, therapeutic options, and disease course in these patients are discussed.
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PMID:Basal arterial occlusive disease. 408 Jan 27

Moyamoya is an intriguing and controversial syndrome. This patient study serves to align the pathophysiology of intracranial hemorrhage in moyamoya with the cerebral vascular disease seen with hypertension, or aging. The historical evidence linking lipohyalinosis and microaneurysms to cerebral hemorrhage is reviewed, the pathogenesis of this angiopathy is discussed, and explanations considered for its association with the vascular pattern of moyamoya. We propose that hemodynamics, genetics or both are among the primary operant etiologic factors.
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PMID:Lipohyalinosis and miliary microaneurysms causing cerebral hemorrhage in a patient with moyamoya. A clinicopathological study. 615 50

Moyamoya disease was originally defined as a characteristic syndrome of recurrent headaches, occlusion of the distal internal carotid arteries and the foggy (moyamoya) clusters of collateral vessels at the base of the brain as demonstrated by cerebral angiography. The etiology is unknown and pathobiology is poorly understood. We examined the intracranial arteries in 3 patients to demonstrate characteristic changes and to obtain a better understanding of the basis mechanisms of the disease. Controls were obtained from 3 normotensive patients who died as a result of cancer. Occluded internal carotid arteries were characterized by severe thickening of the intima with a dense luminal array of smooth muscle cells, a deeper less cellular zone, pronounced tortuosity of the internal elastica and thinning of the media. Collateral vessels were arterial in structure and were affected by similar proliferative changes in the intima, thinning of the media, and contorted internal elastica. Stainable lipids were not part of the typical components. Severe contortion of the internal elastica, medial damage and intimal proliferation may result from recurrent and sustained spasticity of the cerebral arteries. The distal lenticulostriate arteries showed severe medial damage similar to what is termed as a moth-eaten change in hypertensive patients dying of massive cerebral hemorrhage.
Stroke
PMID:Ultrastructural studies of cerebral arteries and collateral vessels in moyamoya disease. 646 67

The effect of surgical treatment upon the intelligence of 20 children with moyamoya disease was evaluated and related to changes in cerebral blood flow (CBF). The patients were treated by various surgical revascularization procedures, mainly by encephalo-myo-synangiosis. Intelligence was tested using the Wechsler intelligence scale for children (WISC) in 19 children and the Wechsler adult intelligence scale (WAIS) in one child. Measurements of regional CBF were performed by a 133Xe inhalation method. In the preoperative state, the degree of reduction in the intelligence quotient (IQ) correlated well with the age of the patients; the older patients revealed a more marked reduction of IQ, and the patients with lower intelligence scores in general showed a tendency for more marked depression of mean CBF. Postoperatively, most of the patients showed increase in IQ, especially in performance IQ which improved significantly in 10 patients, remained unchanged in 3 and deteriorated in 2. Mean CBF increased by an average of 11.4%, and postoperative changes in mean CBF correlated well with the changes in IQ in most patients. This may show that the postoperative increase in CBF is quite possibly responsible for the changes in IQ.
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PMID:Intelligence in children with moyamoya disease: evaluation after surgical treatments with special reference to changes in cerebral blood flow. 647 39

Ninety-two thrombi and/or thromboemboli of cervico-cephalic arteries were confirmed histopathologically in 16 out of 22 patients with moyamoya disease. Included were 74 white thrombi mainly composed of fibrin and platelets, 9 organized thrombi and 9 mixed thrombi containing red blood cells. Thirteen microthrombi and one organized thrombus were located in the cervical arteries. Seventy-eight thrombi were present in the intracranial major arteries. Sixty-five were white microthrombi attached to the luminal surface of the arteries. The intracranial microthrombi were most frequently observed at the distal ends of the internal carotid arteries (29 thrombi). The fibrous thickening of the intima and edema in the innermost luminal surface were the most common vascular alterations associated with the thrombus formation. In two patients, thrombus formation was associated with fissure of the thickened intima and a dissecting aneurysm. We concluded that in patients with moyamoya disease the thrombi may be closely related to the development of intimal thickening in the intracranial arteries, particularly at the distal ends of the internal carotid arteries.
Stroke
PMID:Cervico-cephalic arterial thrombi and thromboemboli in moyamoya disease--possible correlation with progressive intimal thickening in the intracranial major arteries. 670 35

One hundred cases of Moyamoya disease were encountered between 1961 and 1980. This report describes the clinical characteristics and emphasizes the angiographic findings and clinical correlation in this disease. Reasons for the differences in clinical and radiological presentation in children versus adults are proposed and a possible pathophysiological mechanism is outlined. Treatment with perivascular sympathectomy and superior cervical ganglionectomy may be useful but more investigation needs to be carried out into the pathogenesis of the disease before more definitive therapy is realized.
Stroke
PMID:Moyamoya disease--a review. 682 78


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