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Query: UMLS:C0917798 (cerebral ischemia)
 17,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Moyamoya disease is a chronic occlusive cerebrovascular disorder characterized by stenosis of the intracranial internal carotid artery often accompanied by stenosis of the anterior and/or middle cerebral arteries. This results in cerebral ischemia, which manifests clinically as transient, repetitive episodes of hemiplegia, dysarthria, and involuntary movements. This case report documents a patient in whom an initial extracranial-intracranial bypass (superficial temporal-middle cerebral artery) failed to alleviate the ischemic symptoms. In a subsequent procedure, a pedicle graft of omentum was created and through a subcutaneous tunnel was placed on the right cerebral cortex. Over a 2 1/2-year period, this has resulted in a dramatic resolution of the patient's symptomatology. The report delineates the condition and reviews other therapeutic options.
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PMID:Encephalo-omental synangiosis in the management of moyamoya disease. 173 85

Anesthetic management during 85 STA-MCA anastomoses with or without encephalo-myosynangiosis for 64 patients with Moyamoya disease was evaluated retrospectively. Anesthetic agents included nitrous oxide-NLA (GONLA), nitrous oxide-halothane (GOF), nitrous oxide-enflurane (GOE), and their combinations. Slight hypercarbia (40 mmHg less than PaCO2 less than 50 mmHg) was essential to avoid cerebral ischemia. Several procedures to control heart rate by beta blockade or to control hypertension by nitroglycerin were required, because tachycardia and hypertension interfered with fine surgical procedure. During microsurgery HR of GONLA anesthetized patients was significantly lower. Postoperatively the patients anesthetized by GOE showed significantly lower PaCO2 compared with the GONLA anesthetized patients. So we recommend GONLA for anastomosis in patients with Moyamoya disease.
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PMID:[Anesthetic management of revascularization for moyamoya disease]. 192 Jul 89

Progressive stenosis or occlusion of bilateral internal carotid arteries by fibrocellular intimal thickening results in cerebral ischemia in moyamoya disease. The etiology is unknown. We examined cultured arterial smooth muscle cells (SMC) from scalp arteries of five patients with moyamoya disease. In this study we investigated the responsiveness of the cells in culture to serum mitogens including platelet-derived growth factor (PDGF), a major mitogen of SMC, and compared the response to that of cells derived from age-matched control patients. SMC from patients with moyamoya disease proliferated less rapidly in a medium with 15% serum than did control SMC and responded poorly to the addition of PDGF to 5% serum. PDGF alone did not stimulate SMC in a quiescent state to initiate DNA synthesis in moyamoya disease, without serum factors other than bovine serum albumin, though it significantly stimulated the controls. Simultaneous additions of epidermal growth factor, insulin-like growth factor-I, and PDGF stimulated initiation of DNA synthesis in cells from moyamoya disease, but not as much as PDGF alone did in the controls. Although direct correlations with the pathogenesis of the disease remain to be clarified, the results indicate altered interrelations between serum factors and the cellular responses in vessels of moyamoya disease.
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PMID:Altered cellular responses to serum mitogens, including platelet-derived growth factor, in cultured smooth muscle cells derived from arteries of patients with moyamoya disease. 204 Jun 53

Cerebral rCBF, rOEF, rCMRO2, and rCBV in moyamoya disease were studied by means of positron emmission tomography (PET), using 15O as a tracer. Steady-state methods with C15O2 and 15O2 were used to obtain the functional images of rCBF, rCMRO2, and rOEF. The 15O single-inhalation method was used to obtain the rCBV image. Five children (two boys and three girls) with mean age of 11 years and eight normal volunteers with mean age of 31 years were included in the study. The symptoms of moyamoya disease were due to cerebral ischemia, such as transient ischemic attack (TIA), reversible ischemic neurological deficit (RIND), and minor stroke. The interval between the latest ictus and PET scan ranged from 3 days to 3 years 6 months. Physiological parameters (rCBF, rCMRO2 etc.) in cerebral gray matter, cerebral white matter and basal ganglia were calculated from the single functional images. Any, low density areas appearing in X-ray-CT performed just prior to the PET study were carefully excluded from the analysis. The parameters of moyamoya disease were statistically compared with normal control parameters. Though the value of rCBF was slightly higher in moyamoya disease, this difference was not statistically significant. On the other hand, in moyamoya disease rCBV increased significantly in gray matter, white matter, and basal ganglia. The ratio of CBF to CBV is considered to be the index of perfusion pressure and reciprocal of cerebral mean transit time under the normal autoregulation of CBF. This ratio was calculated and compared with the normal value for each tissue.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cerebral circulation and oxygen metabolism in moyamoya disease of ischemic type in children. 326 63

Two nonhypertensive adult patients with asymptomatic occlusion of the middle cerebral artery, in whom caudate head hemorrhage occurred ipsilateral to the occlusive lesion, are described. The mechanism of this hemorrhage is surmised to be identical to that of moyamoya disease: a rupture of the dilated, fragile lenticulostriate artery, which evolved as a collateral channel in response to chronic cerebral ischemia.
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PMID:Caudate head hemorrhage caused by asymptomatic occlusion of the middle cerebral artery. 381 Apr 46

STA-MCA anastomosis was performed in a total of eight patients ranging in age from five to 42 years for treatment of symptomatic Moyamoya disease. All of the patients presented with symptoms of cerebral ischemia. In most cases bilateral procedures were performed at separate operations. No patients have experienced increased neurological deficits as a result of surgery, while the ischemic symptoms have been relieved completely in most cases. The surgical procedure is especially demanding in the treatment of Moyamoya disease, but remains one of the few solutions to the treatment of this disease.
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PMID:The treatment of Moyamoya disease by superficial temporal-middle cerebral artery (STA-MCA) anastomosis. 381 65

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

A 29 year-old pregnant woman with occlusive disease of the internal carotid arteries and formation of collateral networks (moyamoya disease) is reported. Because of moyamoya disease and toxemia of pregnancy, cesarean section was performed at the 38th week of pregnancy. The patient had a second intracranial hemorrhage 7 months after cesarean section. Encephalo-duro-arterio synangiosis (EDAS) was performed for the prevention of further intracranial hemorrhage and at present she is well. Since intracranial hemorrhage is sometimes associated with bearing down and since hyperventilation-induced cerebral ischemia and hypertension are provoked by active labor, elective cesarean section may be recommended for pregnant women with moyamoya disease.
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PMID:Occlusive disease of the internal carotid arteries with vascular collaterals (moyamoya disease) in pregnancy. 395 53

In patients with advanced moyamoya disease, reconstructive surgery alone may not prevent the deterioration of blood flow in the territory of the anterior cerebral artery. These types of surgery include superficial temporal artery-to-middle cerebral artery anastomosis and encephalo-duro-arterio-myo-synangiosis (EDAMS). Bilateral encephalo-duro-arterio-synangiosis (EDAS) gradually reduced the transient ischemic attacks in one of our patients who experienced motor weakness in the left extremities. After surgery, however, persistent bilateral attacks still occurred in the patient's legs. In a subsequent maneuver, we inserted the pedicle of the galea on both sides into the interhemispheric fissure, which induced marked vascularization in the territory of the anterior cerebral artery, and the attacks disappeared. Since then, we have combined this "ribbon" technique with EDAMS to treat eight patients with moyamoya disease. Postoperative angiograms showed widespread collateral circulation on the ischemic brain surface in six patients undergoing ribbon EDAS or EDAMS. Postoperative measurements of cerebral blood flow revealed improved circulation in the frontal region in four patients. The clinical results were excellent in six patients, and good in one, and we lost follow-up in one. The ribbon EDAMS procedure is effective on moyamoya disease with symptomatic cerebral ischemia of the anterior circulation.
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PMID:Ribbon enchephalo-duro-arterio-myo-synangiosis for moyamoya disease. 805 22

Progressive stenosis or occlusion of bilateral internal carotid arteries by fibrocellular intimal thickening results in cerebral ischemia in moyamoya disease. We recently found that cultured smooth muscle cells (SMC) derived from arteries of patients with moyamoya disease responded poorly to serum mitogens, especially to platelet-derived growth factor (PDGF). In the present study, we investigated further the binding and processing of 125I-PDGF, as well as down-regulation of the PDGF receptor in arterial SMC derived from patients with moyamoya disease. The specific binding sites of 125I-PDGF were reduced significantly at both 4 degrees C and 22 degrees C on SMC from moyamoya disease compared with those from control (4.78 vs. 11.92 x 10(4)/cell at 4 degrees C), though the apparent dissociation constant (Kd) were the same. Kinetics of 125I-PDGF binding at 37 degrees C in cells from moyamoya disease showed fewer binding sites (less than 1/3 of controls) and lower degradation per cell than in those from controls, though no difference was observed in either internalization or degradation of each receptor. When SMC were exposed to lower concentrations of nonlabeled PDGF at 37 degrees C, the percentage of remaining binding sites on cells from moyamoya disease was significantly less than that from controls. This excess down-regulation of PDGF receptor in SMC from moyamoya disease may be interpreted as insufficient recycling or a decreased intracellular pool of the PDGF receptor. These results are closely correlated with the diminished proliferation responses to PDGF in SMC from moyamoya disease and provide evidence that functional alterations in vascular cells are involved in the mechanism of development of intimal thickening in moyamoya disease.
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PMID:Kinetics of 125I-PDGF binding and down-regulation of PDGF receptor in arterial smooth muscle cells derived from patients with moyamoya disease. 842 8


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