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

The purpose of this study was to investigate the efficacy and practicality of magnetic resonance angiography (MRA) in evaluating pediatric cerebrovascular disorders. A retrospective evaluation was performed of MR angiograms in 20 pediatric patients with cerebrovascular pathology. When appropriate, comparisons were made with duplex ultrasonography or conventional catheter angiography. MRA accurately assessed the patency of carotid reanastomoses in 8 babies who had previously undergone extracorporeal membrane oxygenation (ECMO). In 6 patients with moyamoya syndrome, MRA accurately evaluated stenotic intracranial carotid and circle of Willis arteries and progressive enlargement of the superficial temporal and middle cerebral arteries after revascularization procedures, and thus obviated the need for sequential angiograms. Thrombi and emboli were identified in 4 of 5 patients with symptoms and imaging evidence of an acute stroke. Two-dimensional time-of-flight MR venograms, acquired in both axial and coronal planes, were useful for preoperative venous mapping in a patient with an occipital encephalocele and detecting venoocclusive disease. MRA provided diagnostically useful information in a spectrum of pediatric cerebrovascular disorders. It can be used as the initial vascular imaging modality for patients with imaging evidence of acute cerebrovascular event, to evaluate progression of chronic vasoocclusive disease, to evaluate vessel patency following intracranial revascularization surgery, and for visualization of the venous circulation.
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PMID:Selected indications for and applications of magnetic resonance angiography in children. 816 86

We report on eight children who suffered from cerebrovascular ischemia or stroke at the age of 2 or up to 11 years. Antiphospholipid antibodies (APLA) were detected in two cases during the ischemic event and in six cases during follow-up examinations (after six weeks or within a span of six years). In two patients multiple stenoses of basal cerebral arteries were found; one of them suffered from moyamoya syndrome. The acute hemiplegia in one patient was linked to an asymptomatic mycoplasmal infection and APLA. In three cases, one of the parents was also APLA-positive. Seven patients were treated with acetylsalicylic acid, and in four cases immunoglobulin infusions were given. Transient ischemic attacks subsided after the child with the moyamoya syndrome received immunoglobulins. No effect of medication could be established in the other children. The concept of the antiphospholipid syndrome is still evolving. As none of the common risk factors pertaining to strokes in adults apply to children, pediatric research may offer a suitable platform for specific investigations on the causal, pathogenetic role of APLA. We propose that all children suffering from stroke or transient ischemic attacks should be tested for APLA.
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PMID:Antiphospholipid antibodies in cerebrovascular ischemia and stroke in childhood. 820 57

A cerebral vasodilatory capacity map, consisting of a 99mTc-DTPA-HSA SPECT image obtained after acetazolamide injection minus the baseline image, was produced in a patient with moyamoya disease. The map demonstrated diminished capacity in the posterior region of the right cerebral hemisphere. Subsequently, cerebral infarction occurred in the corresponding area. This observation suggests that regions of low vasodilatory capacity identified by cerebral vasodilatory capacity mapping may be at high risk of ischemic stroke.
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PMID:Cerebral vasodilatory capacity mapping using technetium-99m-DTPA-HSA SPECT and acetazolamide in moyamoya disease. 822 45

We have encountered 38 cases of juvenile ischemic strokes during the past 10 years, which included 16 cases of moyamoya disease and 22 cases of non-moyamoya strokes. The etiology could not be determined in most non-moyamoya strokes, except in 4 cases of cardiogenic embolism and 1 case of post-meningitic stroke. We further examined 13 cases of idiopathic strokes, which showed clinical symptoms of so-called acute infantile hemiplegia. Nine out of 13 patients developed strokes between 6 months and 2 years of age. Strong male preponderance was noted, since 11 out of 13 patients were boys. CT scan showed basal ganglionic infarction in the territory of the perforating branches of the middle cerebral artery in 12 patients. Recurrence of ischemic events occurred in none of the patients during the mean follow-up period of 48.4 months. Functional recovery was also good, since no neurological sequelae were found in 5 patients, and the other 8 disabled children were able to go to school without help and none of the children were mentally retarded. These results and a review of the literature suggest the importance of traumatic mechanisms in the etiology and pathogenesis of juvenile idiopathic ischemic strokes of the acute infantile hemiplegic type.
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PMID:[Ischemic stroke in childhood]. 832 52

Thirty-one patients with moyamoya disease, who had been treated for encephaloduroarteriosynangiosis (EDAS), encephalomyosynangiosis (EMS) or EMS with encephaloarteriosynangiosis (EAS) in other hospitals, were admitted to Osaka Neurological Institute from January 1985 to September 1991. Twenty-seven of 57 sides treated by indirect anastomosis showed good filling of the middle cerebral artery (MCA) territory via the anastomosis, whereas 16 and 14 showed fair and poor collaterals via the anastomosis, respectively. Twenty-eight cerebral hemispheres treated by indirect anastomosis underwent further surgery and received superficial temporal artery-MCA anastomosis with or without EMS for still-existent recurrent transient ischemic attacks or completed stroke even after the indirect anastomosis. One patient still had recurrent transient ischemic attacks with quadriparesis after bilateral encephaloduroarteriosynangiosis, which had produced no effective collaterals in the MCA territory; the patient then underwent omental transplantation to the bilateral anterior cerebral artery and MCA territories, resulting in the cessation of the transient ischemic attacks. Clinical improvement after superficial temporal artery-MCA anastomosis with or without EMS was noted in all patients, except on one side, where a completed stroke had resulted in fixed neurological deficits. We do not know the reasons for the uncertainty of the development of collaterals via the indirect anastomosis, but there are many patients who still need direct reconstruction of the indirect anastomosis.
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PMID:Surgical reconstruction of failed indirect anastomosis in childhood Moyamoya disease. 832 95

Moyamoya syndrome is defined as the development of collateral anastomosis pathways at the base of the brain, associated with chronic progressive stenosis of the carotid fork. Both reconstructive vascular surgery and conservative strategies are used to treat this syndrome, but the latter cannot prevent the disease from progressing. We describe the procedure of encephalo-duro-arterio-myo-synangiosis (EDAMS), and report the results in 17 patients (28 sides) who underwent EDAMS. The clinical symptoms of moyamoya disease include transient ischemic attacks, reversible ischemic neurological deficits, stroke, seizures, Gerstmann's syndrome, involuntary movements, or mental retardation resulting from the lack of cerebral blood flow. The clinical results of EDAMS were poor in one patient, fair in two, good in five, excellent in eight, and fair on one side and excellent on the other side in one patient. Postoperative angiograms showed widespread collateral circulation on the ischemic brain surface in patients undergoing EDAMS.
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PMID:Surgical treatment of moyamoya disease: operative technique for encephalo-duro-arterio-myo-synangiosis, its follow-up, clinical results, and angiograms. 847 42

We describe the vascular pathologic findings in a 20-year-old Japanese man with Down's syndrome (DS) who developed stroke-like symptoms and died of respiratory failure attributed to a cerebral infarction. The latter was verified at autopsy, which also revealed vascular abnormalities resembling those of moyamoya disease. There were occlusions or stenosis in the bilateral internal carotid arteries, middle cerebral arteries, left posterior communicating artery, and basilar artery due to fibrous hypertrophy of the arterial intimal walls. The tunica media was highly atrophic and the internal elastic lamina was tortuous and duplicate. However, unlike moyamoya disease, main trunks of the cerebral arteries were of normal size, and there was marked stenosis of the basilar artery. These cerebrovascular abnormalities may have been the result of an immune deficiency, thrombosis, maldevelopment of the skull and brain, or may have been linked to moyamoya disease. Further study of similar cases is necessary to clarify the association between DS and moyamoya disease, as well as the pathogenesis of that disease.
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PMID:Autopsy findings in Down's syndrome with cerebrovascular disorder. 879 48

A 30-year-old female and a 38-year-old male developed "definite" moyamoya disease after presenting with "probable" moyamoya disease manifesting as ischemic stroke. Angiography at first presentation demonstrated unilateral involvement with normal contralateral findings. The cases were classified as adult type "probable" moyamoya disease according to the diagnostic criteria. Follow-up angiography demonstrated the occlusive lesions had become bilateral, satisfying the criteria for "definite" cases. Serial angiography is required in adults presenting with "probable" moyamoya disease manifesting as ischemic stroke.
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PMID:Adult moyamoya disease progressing from unilateral to bilateral involvement . 890 9

We report a case of Prader-Willi syndrome (PWS) complicated with juvenile stroke. The patient is a 19-year-old man with right hemiplegia, who has had a history of non-insulin-dependent diabetes mellitus (NIDDM) for ten years. The diagnosis of PWS was confirmed genetically by the method of fluorescence in situ hybridization which showed the deletion of chromosome 15. His brain MRI revealed abnormal signal intensities in the left basal ganglia and around the right trigone of the lateral ventricle. Angiographic examination showed occlusions of bilateral proximal middle cerebral arteries with basal moyamoya vessels. The left vertebral artery was also occluded at its origin. Only a few cases of PWS complicated with stroke have been reported before and, to date, there has been no case with arterial occlusion similar to our case. Though the cause of these arterial occlusions is unknown, it may be related to arteriosclerosis following NIDDM.
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PMID:[A case of Prader-Willi syndrome with bilateral middle cerebral artery occlusion and moyamoya phenomenon]. 893 99

From January 1978 to December 1995, 92 cases of Moyamoya disease were collected from seven major medical centers in Taiwan. The data gave an annual incidence rate of 0.048 per 100,000 population. There were 40 males and 52 females and the ages ranged from 2 to 62 years with the peak incidence in the 31-40 year age group (23 cases). Cerebral infarction occurred in 20 out of 24 juvenile patients (83%), and in 24 out of 68 adult patients (35%). The difference was statistically significant. Haemorrhagic stroke was more frequent in adult patients. Computed tomographic scans following stroke showed cerebral infarction in 44 cases, ventricular haemorrhage in 26 cases, intracerebral haemorrhage in 14 cases and pure subarachnoid haemorrhage in eight. The most frequent initial symptom was motor disturbance (59%), followed by headache (49%) and impaired consciousness (35%). This survey showed an incidence rate much lower than that in Japan, but comparable with those in other Oriental countries and higher than those in Western countries. The male-to-female ratio once differed considerably from that of the Japanese series, but from the present study is now quite similar.
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PMID:Epidemiological study of moyamoya disease in Taiwan. 940 99


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