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Xu J, Zou Z, Liu W, Zhang Q, Shen J, Hao F, Chen G, Yu D, Li Y, Zhang Z, Qin Y, Yang R, Wang Y, Duan L. HAPLN3 p.T34A contributes to incomplete penetrance of moyamoya disease in Chinese carrying RNF213 p.R4810K. Eur J Neurol 2024:e16473. [PMID: 39315749 DOI: 10.1111/ene.16473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/10/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND AND PURPOSE The penetrance of the RNF213 p.R4810K, a founder mutation of moyamoya disease (MMD), is estimated to be only 1/150-1/300. However, the factors affecting its penetrance remain unclear. Therefore, our study aims to identify modifier genes associated with the incomplete penetrance of this founder mutation. METHODS Whole-exome sequencing (WES) was performed on 36 participants, including 22 MMD patients and 14 non-MMD controls with RNF213 p.R4810K mutation. Fisher's exact test was used to assess the presence of genetic variants that differed significantly between MMD patients and non-MMD controls. In order to exclude false-positive results, another 55 carriers were included to perform Fisher's exact test for the selected sites in the WES discovery stage. Subsequently, human brain microvascular endothelial cells were transfected with wild-type and mutant HAPLN3 for tube formation assays and western blotting to explore the impact of candidate genes on angiogenesis. RESULTS Analysis of variants from WES data revealed a total of 12 non-synonymous variants. Through bioinformatics analysis, the focus was on the HAPLN3 p.T34A variant with a significant p value of 0.00731 in Fisher's exact test. Validation through Sanger sequencing confirmed the presence of this variant in the WES data. In vitro experiments revealed that silencing HAPLN3 and transfecting HAPLN3 p.T34A significantly enhanced tube formation and increased the relative protein expression of vascular endothelial growth factor in endothelial cells. CONCLUSIONS These results suggest that HAPLN3 may function as a modifier gene of RNF213 p.R4810K, promoting the development of MMD and contributing to the incomplete penetrance of MMD founder mutations.
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Affiliation(s)
- Jun Xu
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education (China Medical University), Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Zhengxing Zou
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wanyang Liu
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education (China Medical University), Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Qian Zhang
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Juan Shen
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education (China Medical University), Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Fangbin Hao
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Gan Chen
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education (China Medical University), Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Dan Yu
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yunzhu Li
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education (China Medical University), Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Zhengshan Zhang
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yuchen Qin
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education (China Medical University), Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Rimiao Yang
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yue Wang
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education (China Medical University), Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Lian Duan
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
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Li W, Zhao X, Fu J, Cheng L. Identification of lysosome-related hub genes as potential biomarkers and immune infiltrations of moyamoya disease by multiple bioinformatics methods and machine-learning strategies. Heliyon 2024; 10:e34432. [PMID: 39104482 PMCID: PMC11298923 DOI: 10.1016/j.heliyon.2024.e34432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/09/2024] [Accepted: 07/09/2024] [Indexed: 08/07/2024] Open
Abstract
Background Moyamoya disease (MMD), characterized by chronic cerebrovascular pathology, poses a rare yet significant clinical challenge, associated with elevated rates of mortality and disability. Despite intensive research endeavors, the exact biomarkers driving its pathogenesis remain enigmatic. Methods The expression patterns of GSE189993 and GSE141022 were retrieved from the Gene Expression Omnibus (GEO) repository to procure differentially expressed genes (DEGs) between samples afflicted with MMD and those under control conditions. The Least Absolute Shrinkage and Selection Operator (LASSO), Support Vector Machine with Recursive Feature Elimination (SVM-RFE), and Random Forest (RF) algorithms were employed for identifying candidate diagnostic genes associated with MMD. Subsequently, these candidate genes underwent validation in an independent cohort (GSE157628). The CMAP database was ultimately employed to forecast drugs pertinent to MMD for clinical translation. Results A collective of 240 DEGs were discerned. Functional enrichment scrutiny unveiled the enrichment of the cholesterol metabolism pathway, salmonella infection pathway, and allograft rejection pathway within the MMD cohort. EPDR1, DENND3, and NCSTN emerged as discerned diagnostic biomarkers for MMD. The CMAP database was ultimately employed to scrutinize the ten most auspicious pharmaceutical compounds for managing MMD. Finally, after validation through in vitro experiments, EPDR1, DENND3, and NCSTN were identified as the key genes. Conclusion EPDR1, DENND3, and NCSTN have emerged as potential novel biomarkers for MMD. The involvement of T lymphocytes, neutrophilic granulocytes, dendritic cells, natural killer cells, and plasma cells could be pivotal in the pathogenesis and advancement of MMD.
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Affiliation(s)
- Wenyang Li
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Xiang Zhao
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jinxing Fu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lei Cheng
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
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DeDios-Stern SL, Gotra MY, Resch ZJ, Jennette KJ, Amin-Hanjani S, Charbel FT, Alaraj A, Testai FD, Thulborn KR, Vargas A, Pliskin NH, Soble JR. Neuropsychological Test Performance Differentiates Subgroups of Individuals With Adult Moyamoya Disease: A Cross-Sectional Clinical Study. Neurosurgery 2024:00006123-990000000-01185. [PMID: 38836614 DOI: 10.1227/neu.0000000000003010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/01/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Moyamoya disease (MMD) is a rare noninflammatory disorder involving progressive intracranial vasculopathy and impaired cerebral blood flow in the anterior circulation, resulting in stroke and cognitive impairment. We aimed to characterize cognitive impairment and the possible predictive value of sociodemographic and clinical characteristics of adults with MMD. METHODS This cross-sectional study examined neurocognitive performance in a group of 42 consecutive adult patients (mean age = 40.52 years; 69% female) referred for a presurgical neuropsychological evaluation. Neuropsychological functioning was assessed with a comprehensive battery, and cognitive dysfunction was defined as 1.5 SDs below the mean. Neurocognitive performance correlated with clinical/demographic characteristics and disease markers. RESULTS Most patients (91%) had a history of stroke, and 45% had cognitive deficits, most notably on measures of attention/speed (48%), executive functioning (47%), visuoconstruction (41%), and memory (31%-54%). Only higher educational attainment and poor collateral blood flow in the right hemisphere differentiated cognitively impaired (n = 19) and intact groups (n = 23), and MMD-related characteristics (eg, disease duration, stroke history) did not differentiate the 2 groups. CONCLUSION Consistent with previous work, frontal-subcortical cognitive deficits (eg, deficits in mental speed, attention, executive functioning) were found in nearly half of patients with MMD and better cognitive performance was associated with factors related to cognitive reserve. Angiographic metrics of disease burden (eg, Suzuki rating, collateral flow) and hemodynamic reserve were not consistently associated with poorer cognitive outcomes, suggesting that cognition is a crucial independent factor to assess in MMD and has relevance for treatment planning and functional status.
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Affiliation(s)
- Samantha L DeDios-Stern
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neuro Rehabilitation, Chelsea and Westminster Hospital NHS London Trust, London, UK
| | - Milena Y Gotra
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Zachary J Resch
- Department of Neurology, New York University Langone Health, New York, New York, USA
| | - Kyle J Jennette
- Departments of Psychiatry and Neurology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University Hospitals Cleveland Medical Center/Case Western Reserve School of Medicine, Cleveland, Ohio, USA
- Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Keith R Thulborn
- Center for Magnetic Resonance Research, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Alejandro Vargas
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Neil H Pliskin
- Departments of Psychiatry and Neurology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Jason R Soble
- Departments of Psychiatry and Neurology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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Shieh A, Schoenheit TR, Mallon ST, Mathias EJ. Acute Weakness in a Toddler with Sickle Cell Disease. Pediatr Rev 2024; 45:296-300. [PMID: 38689111 DOI: 10.1542/pir.2022-005746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
| | | | - Shane T Mallon
- Division of Emergency Radiology, University of Michigan, Ann Arbor, MI
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Birkeland P, Hansen V, Tharmabalan V, Lauritsen J, Nielsen T, Truelsen T, Rosenbaum S, von Weitzel-Mudersbach P. Long-term stroke risk in Moyamoya disease. Int J Stroke 2024; 19:452-459. [PMID: 37950387 DOI: 10.1177/17474930231216037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Moyamoya disease (MMD) is considered a progressive disease with an ongoing risk of recurrent stroke. However, there is a lack of long-term observational data to quantify the extent of the stroke risk. METHODS This study aimed to provide insight into the long-term stroke risk in MMD and explore possible risk factors for stroke. Records from all patients diagnosed with MMD in 13 clinical departments from 6 different Danish hospitals between 1994 and 2017 were retrospectively reviewed until 2021. RESULTS The cohort comprised 50 patients (33 females and 17 males). Patients were followed up for a median of 9.4 years, with more than 10 years of follow-up for 24 patients. Ten patients had 11 new stroke events-6 ischemic strokes and 5 brain hemorrhages. Events occurred at a median of 7 years and up to 25 years after diagnosis. The overall Kaplan-Meier 5-year stroke risk was 10%. Patients with bypass performed had significantly fewer events than conservatively treated patients (HR 0.25, 95% confidence interval (CI) 0.07-0.91, p < 0.05). All but one event occurred in females, a difference that reached statistical significance. CONCLUSIONS The study provides data on the extent of the risk of recurrent stroke in MMD. Bypass surgery patients had fewer stroke events than those treated conservatively. There was a trend toward a higher stroke risk in females. DATA ACCESS STATEMENT The data supporting this study's findings are available from the corresponding author upon reasonable request.
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Affiliation(s)
- Peter Birkeland
- Department of Neurosurgery, Copenhagen University Hospital, København Ø, Denmark
| | - Victoria Hansen
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Vinosha Tharmabalan
- Department of Neurosurgery, Copenhagen University Hospital, København Ø, Denmark
| | - Jens Lauritsen
- Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Troels Nielsen
- Department of Neurosurgery, Odense University Hospital, Odense C, Denmark
| | - Thomas Truelsen
- Department of Neurology, Copenhagen University Hospital, København Ø, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Bispebjerg Hospital, København, Denmark
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Saccaro LF, Mallet C, Wullschleger A, Sabé M. Psychiatric manifestations in moyamoya disease: more than a puff of smoke? a systematic review and a case-reports meta-analysis. Front Psychiatry 2024; 15:1371763. [PMID: 38585478 PMCID: PMC10995700 DOI: 10.3389/fpsyt.2024.1371763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Moyamoya disease (MMD) is a life-threatening condition characterized by stenosis of intracranial arteries. Despite the frequency and the impact of psychiatric symptoms on the long-term prognosis and quality of life of MMD patients, no systematic review on this topic exists. Methods This systematic review and meta-analysis included 41 studies (29 being case reports), from PubMed, Scopus, Embase until 27/3/2023, on MMD patients exhibiting psychiatric symptoms. Results Despite a fair average quality of the articles, quantitative synthesis through logistic regression was possible only for case reports, due to heterogeneity between the other studies. Psychosis, the most frequent psychiatric symptom reported in case reports, was more frequent in MMD patients with left hemisphere involvement. Neurological symptoms occurrence increased the odds of MMD diagnosis preceding psychiatric symptoms. Psychiatric symptoms are highly prevalent in MMD patients and are relatively often the only presenting symptoms. Discussion We discuss the diagnostic, therapeutic, and prognostic implications of recognizing and characterizing specific psychiatric symptoms in MMD, outlining preliminary guidelines for targeted pharmacological and psychotherapeutic interventions. Lastly, we outline future research and clinical perspectives, striving to enhance the oft-overlooked psychiatric care for MMD patients and to ameliorate their long-term outcome. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023406303.
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Affiliation(s)
- Luigi F. Saccaro
- Psychiatry Department, Geneva University Hospital, Geneva, Switzerland
- Psychiatry Department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Clément Mallet
- Psychiatry Department, Geneva University Hospital, Geneva, Switzerland
| | - Alexandre Wullschleger
- Psychiatry Department, Geneva University Hospital, Geneva, Switzerland
- Psychiatry Department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Michel Sabé
- Psychiatry Department, Geneva University Hospital, Geneva, Switzerland
- Psychiatry Department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Chen J, Zheng H, Wu X, Niu X, Dai Y, Zhou Z, Ye F. Neuregulin 1 as a potential biomarker for disease progression in moyamoya disease: A case-control study in Chinese population. J Stroke Cerebrovasc Dis 2024; 33:107581. [PMID: 38224792 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/07/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE Moyamoya disease (MMD) is a rare and progressive stenosis of cerebral arteries characterized by abnormally proliferative vasculopathy. Current studies have demonstrated that Neuregulin 1 (NRG1) plays a key role in angiogenesis-related disorders. Thus, the aim of our study is to investigate the serum NRG1 levels and their clinical correlations in MMD patients. METHODS In this study, thirty adult patients with MMD and age-gender matched healthy controls were enrolled from our hospital between July 2020 and April 2022. Peripheral blood samples were collected at baseline, and clinical data were obtained from the electronic medical record system. Serum NRG1 concentrations were measured by enzyme-linked immunosorbent assay. Sanger sequencing was applied to detect the RNF213 p.R4810K mutation. RESULTS The serum NRG1 levels were significantly higher in MMD patients compared to controls (14.48 ± 10.81 vs.7.54 ± 6.35mmol/L, p < 0.001). No statistical difference in baseline clinical characteristics was found between both groups. Correlation analyses showed that NRG1 levels were positively associated with Suzuki staging (r = 0.4137, p = 0.023) while not related to other clinical features (reduced cerebral blood flow, posterior cerebral artery involvement, bilateral or unilateral steno-occlusive changes). Furthermore, subgroup analysis revealed that MMD patients with the RNF213 p.R4810K mutation presented with significantly higher NRG1 levels than those without the mutation (9.60 ± 0.929 vs. 25.89 ± 4.338 mmol/L, p = 0.001). CONCLUSIONS Our study suggests that increased serum NRG1 levels may constitute a characteristic feature of MMD, indicating a potential positive correlation with disease progression and the presence of the RNF213 mutation. This positions NRG1 as a potentially crucial target for further studies aimed at comprehending the pathogenesis of MMD.
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Affiliation(s)
- Jie Chen
- Department of Neurology and Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hanyue Zheng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxin Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingyang Niu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuanyuan Dai
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenhua Zhou
- Department of Neurology and Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
| | - Fei Ye
- Department of Neurology and Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
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Toh KZX, Koh MY, Loh EDW, Sia CH, Chong Y, Yeo LLL, Sharma VK, Lim MJR, Tan BYQ. Prevalence and Associations of Cognitive Impairment in Adult Patients with Moyamoya Disease: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2024; 97:541-552. [PMID: 38108354 DOI: 10.3233/jad-230979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Cognitive impairment, and in the long term Alzheimer's disease, vascular, or mixed dementia, are potential complications of moyamoya disease (MMD), of which the prevalence and associations are not well established. OBJECTIVE We performed a systematic review and meta-analysis to investigate the prevalence of cognitive impairment in adult patients with MMD as well as its clinical and demographic correlates. METHODS We performed a systematic search of four electronic databases: PubMed (MEDLINE), EMBASE, Scopus, and Cochrane Library, profiling studies from inception until 7 May 2023. Clinical data consisting of population characteristics, comorbidities, cognitive assessment tools used, and prevalence of cognitive impairment was extracted. RESULTS Seventeen studies were included in the meta-analysis, with a total study population of 1,190 patients. All studies assessed cognition, and the overall prevalence of cognitive impairment in MMD patients was 54.59%. A subgroup analysis identified that the prevalence of executive dysfunction in MMD patients was 31.55%. We performed a meta-regression analysis which identified that cognitive impairment was not associated with age, education level, or a history of ischemic or hemorrhagic stroke. CONCLUSIONS A substantial proportion of MMD patients have cognitive impairment, and cognitive impairment was found to have no association with a history of stroke. Further research is necessary to investigate the longitudinal relationship of MMD and cognitive impairment, and the impact of bypass surgery on cognitive impairment.
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Affiliation(s)
- Keith Z X Toh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ming Yi Koh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Enver D W Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Yaofeng Chong
- Department of Medicine, Division of Neurology, National University Hospital, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Neurology, National University Hospital, Singapore
| | - Vijay K Sharma
- Department of Medicine, Division of Neurology, National University Hospital, Singapore
| | - Mervyn J R Lim
- Department of Surgery, Division of Neurosurgery, National University Hospital, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Neurology, National University Hospital, Singapore
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Maehara N, Nakamizo A, Arimura K, Yoshimoto K. Memory, Executive, and Intellectual Functions in Adults with Moyamoya Disease. World Neurosurg 2023; 180:e474-e483. [PMID: 37777176 DOI: 10.1016/j.wneu.2023.09.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Cognitive function can decline in adults with moyamoya disease (MMD). Memory, which is an essential but complex and multifaceted function, underpins executive and intellectual functions. However, the relationship between memory and executive or intellectual functions in adults with MMD has not been well studied. The relationship between memory and cerebral blood flow has also not been elucidated. This study investigated correlations between memory, executive function, and intellectual function, and associations between cerebral blood flow and memory in adults with MMD. METHODS Memory, executive function, and intellectual function were assessed using the Wechsler Memory Scale-Revised (WMS-R), Frontal Assessment Battery (FAB), and Wechsler Adult Intelligence Scale (WAIS) third or fourth edition, respectively, in 31 adults with MMD. Cerebral blood flow was measured with iodine 123I-iodoamphetamine single-photon emission computed tomography. RESULTS WMS-R scores correlated significantly with total FAB and WAIS scores before and after revascularization. Cerebral blood flow in the left posterior cerebral artery territory correlated positively with WMS-R and WAIS scores pre- and postoperatively. Postoperative cerebrovascular reserves of the right cerebellum, pons, and vermis were positively associated with visual memory, and postoperative cerebrovascular reserve of the pons was also associated with general memory. CONCLUSIONS Memory function correlates with executive and intellectual functions in adults with MMD. The FAB, which requires about 10 min to administer, might be useful to screen for memory dysfunction. Memory might be vulnerable to hypoperfusion in the posterior cerebral artery territory among adults with MMD. Postoperative cerebrovascular reserve might help predict memory dysfunction in adults with MMD.
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Affiliation(s)
- Naoki Maehara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Nakamizo
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Koichi Arimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Li J, He Q, Liu C, Zeng C, Tao C, Zhai Y, Liu W, Zhang Q, Wang R, Zhang Y, Ge P, Zhang D, Zhao J. Integrated analysis of the association between methionine cycle and risk of moyamoya disease. CNS Neurosci Ther 2023; 29:3212-3227. [PMID: 37183324 PMCID: PMC10580345 DOI: 10.1111/cns.14254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE The role of methionine (Met) cycle in the pathogenesis and progression of cardiovascular and cerebrovascular diseases has been established, but its association with moyamoya disease (MMD) has rarely been studied. This study aimed to analyze the levels of Met cycle-related metabolites and constructed a risk model to explore its association with the risk of MMD. METHODS In this prospective study, a total of 302 adult MMD patients and 88 age-matched healthy individuals were consecutively recruited. The serum levels of Met cycle-related metabolites were quantified by liquid chromatography-mass spectrometry (LC-MS). Participants were randomly divided into training set and testing set at a ratio of 1:1. The training set was used to construct the risk score model by LASSO regression. The association between Met cycle-related risk score and the risk of MMD was analyzed using logistic regression and assessed by ROC curves. The testing set was used for validation. RESULTS The levels of methionine sulfoxide and homocysteine were significantly increased, while the levels of betaine and choline were significantly decreased in MMD and its subtypes compared to healthy controls (p < 0.05 for all). The training set was used to construct the risk model and the risk score of each participant has been calculated. After adjusting for potential confounders, the risk score was independently associated with the risk of MMD and its subtypes (p < 0.05 for all). We then divided the participants into low-risk and high-risk groups, the high-risk score was significantly associated with the risk of MMD and its subtypes (p < 0.05 for all). The risk scores were further assessed as tertiles, the highest tertile was significantly associated with a higher risk of MMD and its subtypes compared to the lowest (p < 0.05 for all). The results were validated in the testing set. CONCLUSION This study has constructed and validated a risk model based on Met cycle-related metabolites, which was independently associated with the risk of MMD and its subtypes. The findings provided a new perspective on the risk evaluation and prevention of MMD.
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Affiliation(s)
- Junsheng Li
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Chenglong Liu
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Chaofan Zeng
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Chuming Tao
- Department of NeurosurgeryThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Yuanren Zhai
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Wei Liu
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Peicong Ge
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
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Yeom I, Oh WO. Development and effects of salutogenesis program for adolescents with moyamoya disease: A randomized controlled trial. PLoS One 2023; 18:e0284015. [PMID: 37883389 PMCID: PMC10602295 DOI: 10.1371/journal.pone.0284015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/15/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Disease-specific interventions for management and health behavior implementation are needed to improve the health and quality of life of adolescents with moyamoya disease. OBJECTIVE This study aimed to develop a program for adolescents with moyamoya disease based on the salutogenesis theory, which focuses on the process of enhancing health through successful adaptation to external stressors, and to evaluate its effectiveness. METHODS A randomized controlled trial was performed according to the CONSORT guidelines. This preliminary research and experimental treatment were conducted at a Severance Hospital ward and outpatient clinic among 48 participants randomized into the intervention (seven sessions of salutogenesis program, n = 24) or the control group (one session of one-to-one moyamoya disease education program, n = 24) from September 6, 2018 to January 4, 2019. Changes in the following study outcomes were reported: "knowledge of moyamoya disease," "social support," "sense of coherence," "moyamoya disease health behavior," "stress," "depression," "subjective health status," "frequency of ischemic symptoms," and "quality of life". RESULTS The salutogenesis program improved the knowledge and social support of adolescents with illness-related problems and helped them attain healthy behaviors and stress reduction. It was confirmed to be effective in improving their quality of life. CONCLUSIONS The salutogenesis program for adolescents with moyamoya disease effectively improved the generalized resistance resources and sense of coherence in adolescents with moyamoya disease. TRIAL REGISTRATION Korean Clinical Research Information Service registry, KCT0006869.
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Affiliation(s)
- Insun Yeom
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Won-oak Oh
- College of Nursing, Korea University, Seoul, Republic of Korea
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12
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Zhang G, Liu E, Tan X, Liu C, Yang S. Research progress on moyamoya disease combined with thyroid diseases. Front Endocrinol (Lausanne) 2023; 14:1233567. [PMID: 37900127 PMCID: PMC10600369 DOI: 10.3389/fendo.2023.1233567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/04/2023] [Indexed: 10/31/2023] Open
Abstract
Moyamoya disease (MMD), also known as abnormal cerebral vascular network disease, is characterized by progressive occlusion or stenosis of the internal carotid and cerebral arteries, as well as the formation of an abnormal cerebral vascular network. It can occur anywhere in the world but is most common in China, Japan, and the Republic of Korea. In recent years, there have been increasing reports on the coexistence of thyroid diseases and MMD, but the mechanism of their coexistence is still unclear. For this article, we used keywords such as "moyamoya disease", "thyroid", "Grave disease", "thyrotoxicosis", and "thyroid autoimmune antibodies" to search for 52 articles that met the requirements in medical databases such as PubMed and Web of Science. This article also reviews the research on the role of thyroid hormone, the mechanism of immune antibodies, the possible correlation between thyroid diseases and MMD disease genes, and the treatment methods, and discusses the possible relationship between MMD and thyroid diseases to provide a reference for the pathogenesis and treatment of MMD with thyroid diseases.
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Affiliation(s)
- Guibo Zhang
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- The First People’s Hospital of Yunnan Province, Kunming, China
| | - Erheng Liu
- Department of Neurosurgery, Kaiyuan Municipal People’s Hospital, Kaiyuan, China
| | - XueYi Tan
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- The First People’s Hospital of Yunnan Province, Kunming, China
| | - Chengyuan Liu
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- The First People’s Hospital of Yunnan Province, Kunming, China
| | - Shuaifeng Yang
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- The First People’s Hospital of Yunnan Province, Kunming, China
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13
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Gonzalez NR, Amin-Hanjani S, Bang OY, Coffey C, Du R, Fierstra J, Fraser JF, Kuroda S, Tietjen GE, Yaghi S. Adult Moyamoya Disease and Syndrome: Current Perspectives and Future Directions: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2023; 54:e465-e479. [PMID: 37609846 DOI: 10.1161/str.0000000000000443] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Adult moyamoya disease and syndrome are rare disorders with significant morbidity and mortality. A writing group of experts was selected to conduct a literature search, summarize the current knowledge on the topic, and provide a road map for future investigation. The document presents an update in the definitions of moyamoya disease and syndrome, modern methods for diagnosis, and updated information on pathophysiology, epidemiology, and both medical and surgical treatment. Despite recent advancements, there are still many unresolved questions about moyamoya disease and syndrome, including lack of unified diagnostic criteria, reliable biomarkers, better understanding of the underlying pathophysiology, and stronger evidence for treatment guidelines. To advance progress in this area, it is crucial to acknowledge the limitations and weaknesses of current studies and explore new approaches, which are outlined in this scientific statement for future research strategies.
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14
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Vassilopoulou S, Tountopoulou A, Korompoki E, Papageorgiou G, Kasselimis D, Velonakis G, Chatziioannou A, Potagas C, Spengos K. Moyamoya Disease: Clinical and Radiological Characteristics in Adult Greek Patients. J Clin Med 2023; 12:5951. [PMID: 37762892 PMCID: PMC10531977 DOI: 10.3390/jcm12185951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND AND PURPOSE The aim of our study is to present, for the first time, the clinical, radiological, and neurocognitive characteristics of Greek adult patients with Moyamoya disease (MMD). METHODS We analyzed prospectively collected data of 12 patients referred to our department from 2004 to 2019. All patients underwent a thorough diagnostic work up, including extensive clinical, neuroradiological, and neurocognitive assessment. RESULTS Our study population consisted of 7 females and the median age at the time of the diagnosis was 43.5 years. No patient had a positive family history of the disease and roughly 50% were hypertensives. Ten patients presented with transient or permanent cerebrovascular ischemia and two patients suffered from hemorrhagic complications. The median NIHSS was 7.5 (0-23) and clinical status remained stable during follow-up with conservative treatment in most of the patients. The majority (83.3%) had bilateral disease confirmed by DSA. All lesions exclusively affected the anterior circulation, with 50% of patients presenting with stenoocclusive changes. No aneurysm or AVM were revealed. The most common neurocognitive deficits were in the executive and language domains. CONCLUSIONS Our MMD patients had a later onset of the disease and an absence of familial occurrence. The most common manifestation was ischemia, transient or permanent, and all lesions affected the anterior circulation, whereas no vascular malformations (AVM, aneurysms) were demonstrated in brain imaging. These findings in Greek patients imply a probable different, Mediterranean phenotype.
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Affiliation(s)
- Sofia Vassilopoulou
- Stroke Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Argyro Tountopoulou
- Stroke Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Eleni Korompoki
- Stroke Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Georgios Papageorgiou
- Neuropsychology and Language Disorders Unit, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.K.)
| | - Dimitrios Kasselimis
- Neuropsychology and Language Disorders Unit, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.K.)
- Department of Psychology, Panteion University of Social and Political Sciences, 17671 Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Achilles Chatziioannou
- 1st Department of Radiology, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Constantin Potagas
- Neuropsychology and Language Disorders Unit, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.K.)
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15
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Oh WO, Park IT, Han J, Lee E, Lee A. Development of a mobile application based on the salutogenic model for self-management in adolescents with Moyamoya disease. J Pediatr Nurs 2023; 72:63-72. [PMID: 37086628 DOI: 10.1016/j.pedn.2023.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/19/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE Moyamoya disease (MMD) is a rare disease which has a high incidence of onset in adolescence. Disease self-management skills are imperative for adolescents with MMD. This study aimed to describe the systematic development, content, and usability of the Moyamoya Healthy Youth application (app), which was developed to enhance self-management skills for adolescents with MMD. DESIGN AND METHODS The theoretical grounding for the app was salutogenic model and the development process of the app was guided by the intervention mapping (IM) protocol. Results of each IM step were applied to the next step leading to the design of the app. Additionally, a pilot test was conducted to determine the usability of the app. RESULTS Following the salutogenic model, we identified the stressors, behaviors, and resources regarding managing symptoms of MMD by interviewing adolescents with MMD, their parents, and healthcare providers. Based on the findings of the interviews, we determined the program outcomes and performance objectives to improve the self-management of MMD in adolescents. The app was developed by translating the theoretical methods to achieve the performance objectives into practical strategies for delivering the program. A pilot test with eight participants showed satisfaction with the app in terms of its usefulness and ease of use. CONCLUSION We delineated the development process of the Moyamoya Healthy Youth. Additionally, we presented the positive outcomes regarding the usability of the app. PRACTICE IMPLICATIONS The Moyamoya Healthy Youth app could benefit adolescents with MMD, by improving their self-management skills which are crucial for their health.
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Affiliation(s)
- Won-Oak Oh
- Korea University, College of Nursing, Seoul, Republic of Korea.
| | - Il Tae Park
- Woosong University, College of Health and Welfare, Daejeon, Republic of Korea
| | - Jihee Han
- Korea University, College of Nursing, Seoul, Republic of Korea
| | - Eunji Lee
- Korea University, College of Nursing, Seoul, Republic of Korea.
| | - Anna Lee
- Yonsei University, College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea.
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16
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Zanoni P, Steindl K, Sticht H, Oneda B, Joset P, Ivanovski I, Horn AHC, Cabello EM, Laube J, Zweier M, Baumer A, Rauch A, Khan N. The genetic landscape and clinical implication of pediatric Moyamoya angiopathy in an international cohort. Eur J Hum Genet 2023; 31:784-792. [PMID: 37012328 PMCID: PMC10325976 DOI: 10.1038/s41431-023-01320-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/16/2022] [Accepted: 02/13/2023] [Indexed: 04/05/2023] Open
Abstract
Pediatric Moyamoya Angiopathy (MMA) is a progressive intracranial occlusive arteriopathy that represents a leading cause of transient ischemic attacks and strokes in childhood. Despite this, up to now no large, exclusively pediatric MMA cohort has been subjected to systematic genetic investigation. In this study, we performed molecular karyotyping, exome sequencing and automated structural assessment of missense variants on a series of 88 pediatric MMA patients and correlated genetic, angiographic and clinical (stroke burden) findings. The two largest subgroups in our cohort consisted of RNF213 and neurofibromatosis type 1 (NF1) patients. While deleterious RNF213 variants were associated with a severe MMA clinical course with early symptom onset, frequent posterior cerebral artery involvement and higher stroke rates in multiple territories, NF1 patients had a similar infarct burden compared to non-NF1 individuals and were often diagnosed incidentally during routine MRIs. Additionally, we found that MMA-associated RNF213 variants have lower predicted functional impact compared to those associated with aortic disease. We also raise the question of MMA as a feature of recurrent as well as rare chromosomal imbalances and further support the possible association of MMA with STAT3 deficiency. In conclusion, we provide a comprehensive characterization at the genetic and clinical level of a large exclusively pediatric MMA population. Due to the clinical differences found across genetic subgroups, we propose genetic testing for risk stratification as part of the routine assessment of pediatric MMA patients.
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Affiliation(s)
- Paolo Zanoni
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland.
| | - Katharina Steindl
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland
| | - Heinrich Sticht
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, 91054, Germany
| | - Beatrice Oneda
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland
| | - Pascal Joset
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland
| | - Ivan Ivanovski
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland
| | - Anselm H C Horn
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, 91054, Germany
| | - Elena M Cabello
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland
| | - Julia Laube
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland
| | - Markus Zweier
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland
| | - Alessandra Baumer
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland
| | - Anita Rauch
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, 8952, Switzerland.
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, 8000, Switzerland.
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, 8000, Switzerland.
- Moyamoya Center, University Children's Hospital, University of Zurich, Zurich, 8032, Switzerland.
| | - Nadia Khan
- Moyamoya Center, University Children's Hospital, University of Zurich, Zurich, 8032, Switzerland.
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17
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Abstract
Differences exist between genders in intracerebral hemorrhage cause, epidemiology, and outcomes. These gender differences are in part attributable to physiologic differences; however, demographic, social/behavioral risk factors, along with health care system variation and potential family and/or clinician bias play a role as well. These factors vary from region to region and interact, making comprehensive and definitive conclusions regarding sex differences a challenging task. Differences between the genders in intracerebral hemorrhage epidemiology and extensive differences in underlying pathophysiology, intervention, risk factors, and outcome are all discussed.
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Affiliation(s)
- Nicholas Dykman Osteraas
- Department of Neurological Sciences, Division of Cerebrovascular Diseases, Rush University Medical Center, 1725 West Harrison Street Suite 118, Chicago, IL 60612, USA.
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18
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Wiedmann MK, Steinsvåg IV, Dinh T, Vigeland MD, Larsson PG, Hjorthaug H, Sheng Y, Mero IL, Selmer KK. Whole-exome sequencing in moyamoya patients of Northern-European origin identifies gene variants involved in Nitric Oxide metabolism: A pilot study. BRAIN & SPINE 2023; 3:101745. [PMID: 37383439 PMCID: PMC10293314 DOI: 10.1016/j.bas.2023.101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 06/30/2023]
Abstract
Introduction Moyamoya disease (MMD) is a chronic cerebrovascular steno-occlusive disease of largely unknown etiology. Variants in the RNF213 gene are strongly associated with MMD in East-Asia. In MMD patients of Northern-European origin, no predominant susceptibility variants have been identified so far. Research question Are there specific candidate genes associated with MMD of Northern-European origin, including the known RNF213 gene? Can we establish a hypothesis for MMD phenotype and associated genetic variants identified for further research? Material and methods Adult patients of Northern-European origin, treated surgically for MMD at Oslo University Hospital between October 2018 to January 2019 were asked to participate. WES was performed, with subsequent bioinformatic analysis and variant filtering. The selected candidate genes were either previously reported in MMD or known to be involved in angiogenesis. The variant filtering was based on variant type, location, population frequency, and predicted impact on protein function. Results Analysis of WES data revealed nine variants of interest in eight genes. Five of those encode proteins involved in nitric oxide (NO) metabolism: NOS3, NR4A3, ITGAV, GRB7 and AGXT2. In the AGXT2 gene, a de novo variant was detected, not previously described in MMD. None harboured the p.R4810K missense variant in the RNF213 gene known to be associated with MMD in East-Asian patients. Discussion and conclusion Our findings suggest a role for NO regulation pathways in Northern-European MMD and introduce AGXT2 as a new susceptibility gene. This pilot study warrants replication in larger patient cohorts and further functional investigations.
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Affiliation(s)
- Markus K.H. Wiedmann
- Department of Neurosurgery, The National Hospital, Oslo University Hospital, Oslo, Norway
| | - Ingunn V. Steinsvåg
- Department of Medical Genetics, Oslo University Hospital and the University of Oslo, Oslo, Norway
| | - Tovy Dinh
- Department of Neurosurgery, The National Hospital, Oslo University Hospital, Oslo, Norway
| | - Magnus D. Vigeland
- Department of Medical Genetics, Oslo University Hospital and the University of Oslo, Oslo, Norway
| | - Pål G. Larsson
- Department of Neurosurgery, The National Hospital, Oslo University Hospital, Oslo, Norway
| | - Hanne Hjorthaug
- Department of Medical Genetics, Oslo University Hospital and the University of Oslo, Oslo, Norway
| | - Ying Sheng
- Department of Medical Genetics, Oslo University Hospital and the University of Oslo, Oslo, Norway
| | - Inger-Lise Mero
- Department of Medical Genetics, Oslo University Hospital and the University of Oslo, Oslo, Norway
| | - Kaja K. Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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19
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Patzig DMM, Forbrig PDMR, Küpper DMC, Eren DMOE, Masouris DMI, Saam PDMT, Kellert PDML, Liebig PDMT, Schöberl PDMF. Evaluation of vessel-wall contrast-enhancement on high-resolution MRI in European patients with Moyamoya disease. J Stroke Cerebrovasc Dis 2023; 32:107135. [PMID: 37079960 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES Data regarding MR vessel-wall imaging (VWI) in patients with Moyamoya disease (MMD) is sparse, particularly in non-asian cohorts. We contribute data regarding the frequency of vessel wall contrast-enhancement (VW-CE) and its potential clinical significance in a European patient group. MATERIALS AND METHODS Patients with a diagnosis of MMD who were examined by VWI were included in the study. VW-CE of stenoocclusive lesions of the terminal internal carotid artery and/or its proximal branches was rated qualitatively. Changes of VW-CE on available follow-up were recorded. VW-CE was correlated with diffusion-restricted lesions and magnetic resonance angiography (MRA) findings. RESULTS Eleven patients (eight female, three male) were included. Twenty-eight stenoocclusive lesions were analyzed, of which 16 showed VW-CE (57.1%). VW-CE was mostly concentric (n=15), rather than eccentric (n=1). In all three patients in whom follow-up VWI was available, changes of VW-CE were documented. Diffusion-restricted lesions were more frequently related to stenoocclusive lesions with VW-CE (n=9) than without VW-CE (n=2), bordering statistical significance. The affected arteries were assessed as stenotic and as occluded in 14 cases each and VW-CE was seen significantly more often in stenotic (n=12) than in occluded arteries (n=4). No correlation was found between the presence of VW-CE and moyamoya stages determined by MRA. CONCLUSIONS Our data suggest that concentric VW-CE is a relatively frequent finding in European MMD patients. VW-CE may change over time and occur in certain stages, possibly representing "active stenosing". Larger studies are needed to validate these findings and determine the clinical relevance of VW-CE in MMD.
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Affiliation(s)
- Dr Med Maximilian Patzig
- Institute of Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany; Radiologie Augsburg Friedberg, Augsburg, Germany, Phone: +49 89 440072501.
| | - Pd Dr Med Robert Forbrig
- Institute of Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440072501.
| | - Dr Med Clemens Küpper
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440073690.
| | - Dr Med Ozan Emre Eren
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440073690.
| | - Dr Med Ilias Masouris
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440073690.
| | - Prof Dr Med Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Germany; Die Radiologie, Rosenheim, Germany, Phone: +89 8031 230970.
| | - Prof Dr Med Lars Kellert
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440073690.
| | - Prof Dr Med Thomas Liebig
- Institute of Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440072501.
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Wen Y, Gou Y, Wang B, Wang Z, Chen S, Zhang S, Zhang G, Li M, Feng W, Qi S, Wang G. Is
STA
really a low‐flow graft? A quantitative ultrasonographic study of the flow of
STA
for cerebral revascularization in
MMD
patients. CNS Neurosci Ther 2023. [PMID: 37002791 PMCID: PMC10401118 DOI: 10.1111/cns.14197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Direct revascularization remains an important tool in the treatment of patients with Moyamoya disease (MMD). The superficial temporal artery (STA) is the most commonly used donor vessel for direct bypass, and an STA graft has traditionally been considered a low-flow graft for flow augmentation. This study aimed to quantitatively evaluate the blood flow of the STA after direct revascularization. METHODS All direct revascularization procedures performed between 2018 and 2021 by one experienced neurosurgeon were screened. Quantitative ultrasound was used to measure the flow data of the patient's bilateral parietal branch of the STA(STA-PB), the bilateral frontal branch of the STA(STA-FB), and the left radial artery. Data on the patients' basic information, Suzuki grade, Matsushima type, anastomosis type, and blood biochemical parameters were collected and analyzed using univariate and multivariate models. An MBC Scale scoring system was proposed to evaluate the recipient artery network of the middle cerebral artery (MCA) tree. The relationship between MBC Scale score and STA graft flow was statistically analyzed. RESULTS In total, 81 patients (43 males and 38 females) successfully underwent STA-MCA bypass and were included in this study. The mean flow rates in the STA-PB graft on 1 day preoperatively, 1 day postoperatively, 7 days postoperatively, and >6 months postoperatively (long-term) were 10.81, 116.74, 118.44, and 56.20 mL/min respectively. Intraoperative graft patency was confirmed in all patients. Comparing the preoperative and all postoperative time points, the STA-PB flow rates were statistically significant (p < 0.001). The MCA-C score was significantly associated with postoperative flow rate on day 1 (p = 0.007). CONCLUSION The STA is a useful donor artery for direct revascularization inpatients with MMD and can provide sufficient blood supply to the ischemic cerebral territory.
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Affiliation(s)
- Yunyu Wen
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Yanxia Gou
- Department of Stomatology, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Baoping Wang
- Department of Ultrasound, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Zhibin Wang
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Siyuan Chen
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Shichao Zhang
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Guozhong Zhang
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Mingzhou Li
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Wenfeng Feng
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Gang Wang
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
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21
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Bersano A, Khan N, Fuentes B, Acerbi F, Canavero I, Tournier-Lasserve E, Vajcoczy P, Zedde ML, Hussain S, Lémeret S, Kraemer M, Herve D. European Stroke Organisation (ESO) Guidelines on Moyamoya angiopathy: Endorsed by Vascular European Reference Network (VASCERN). Eur Stroke J 2023; 8:55-84. [PMID: 37021176 PMCID: PMC10069176 DOI: 10.1177/23969873221144089] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/16/2022] [Indexed: 02/05/2023] Open
Abstract
The European Stroke Organisation (ESO) guidelines on Moyamoya Angiopathy (MMA), developed according to ESO standard operating procedure and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, were compiled to assist clinicians in managing patients with MMA in their decision making. A working group involving neurologists, neurosurgeons, a geneticist and methodologists identified nine relevant clinical questions, performed systematic literature reviews and, whenever possible, meta-analyses. Quality assessment of the available evidence was made with specific recommendations. In the absence of sufficient evidence to provide recommendations, Expert Consensus Statements were formulated. Based on low quality evidence from one RCT, we recommend direct bypass surgery in adult patients with haemorrhagic presentation. For ischaemic adult patients and children, we suggest revascularization surgery using direct or combined technique rather than indirect, in the presence of haemodynamic impairment and with an interval of 6–12 weeks between the last cerebrovascular event and surgery. In the absence of robust trial, an Expert Consensus was reached recommending long-term antiplatelet therapy in non-haemorrhagic MMA, as it may reduce risk of embolic stroke. We also agreed on the utility of performing pre- and post- operative haemodynamic and posterior cerebral artery assessment. There were insufficient data to recommend systematic variant screening of RNF213 p.R4810K. Additionally, we suggest that long-term MMA neuroimaging follow up may guide therapeutic decision making by assessing the disease progression. We believe that this guideline, which is the first comprehensive European guideline on MMA management using GRADE methods will assist clinicians to choose the most effective management strategy for MMA.
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Affiliation(s)
- Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nadia Khan
- Moyamoya Center, University Children’s Hospital Zurich, Switzerland
- Moyamoya Center for adults, Department of Neurosurgery, University Tubingen, Germany
| | - Blanca Fuentes
- Department of Neurology and Stroke Center, Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - Francesco Acerbi
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabella Canavero
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Peter Vajcoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Germany
| | - Maria Luisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Italy
| | | | | | - Markus Kraemer
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Dominique Herve
- CNVT-CERVCO et département de Neurologie, Hôpital Lariboisière, APHP Nord, Paris, France
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22
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Oh WO, Shim KW, Yeom IS, Park IT, Heo YJ, Han J. Risk and protective factors for a salutogenic sense of health in adolescents with Moyamoya disease. Int J Nurs Pract 2023; 29:e13066. [PMID: 35644528 DOI: 10.1111/ijn.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/03/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To identify the risk and protective factors affecting a salutogenic sense of health in adolescents with Moyamoya disease based on Antonovsky's salutogenesis theory. METHODS This study used a qualitative descriptive design. We interviewed adolescents diagnosed with Moyamoya disease and their parents and experts with experience in treating them from 4 July 2019 to 10 October 2019. Data analysis was performed according to the process of deductive content analysis based on Antonovsky's salutogenesis theory. RESULTS This study identified risk and protective factors affecting a salutogenic sense of health in adolescents with Moyamoya disease. Risk factors were closely related to problems with friends, parent relationships and academic work. Protective factors were identified as emotional support through interpersonal relationships, positive attitudes to the disease situation, ability to understand and predict patterns of symptoms, increasing strength to resolve the state of tension and developing available resources. CONCLUSION The factors affecting a salutogenic sense of health in adolescents were identified reflecting on the characteristics of the developmental stage of adolescents and the symptoms and situations that are unique to adolescents. It is important for adolescents with Moyamoya disease to recognize available resources and use them appropriately to successfully manage the state of tension caused by stress.
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Affiliation(s)
- Won-Oak Oh
- College of Nursing, Korea University, Seoul, South Korea
| | - Kyu Won Shim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - In-Sun Yeom
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Il Tae Park
- College of Nursing, Korea University, Seoul, South Korea.,Department of Nursing, Woosong University, Daejeon, South Korea
| | - Yoo Jin Heo
- College of Nursing, Korea University, Seoul, South Korea
| | - Jihee Han
- College of Nursing, Korea University, Seoul, South Korea
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23
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Mertens R, Acker G, Kersting K, Lange C, Furth C, Beyaztas D, Truckenmueller P, Moedl L, Spruenken ED, Czabanka M, Vajkoczy P. Validation of the Berlin Grading System for moyamoya angiopathy with the use of [ 15O]H 2O PET. Neurosurg Rev 2022; 46:25. [PMID: 36574089 PMCID: PMC9794537 DOI: 10.1007/s10143-022-01920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/05/2022] [Accepted: 11/30/2022] [Indexed: 12/28/2022]
Abstract
The Berlin Grading System assesses clinical severity of moyamoya angiopathy (MMA) by combining MRI, DSA, and cerebrovascular reserve capacity (CVRC). Our aim was to validate this grading system using [15O]H2O PET for CVRC. We retrospectively identified bilateral MMA patients who underwent [15O]H2O PET examination and were treated surgically at our department. Each hemisphere was classified using the Suzuki and Berlin Grading System. Preoperative symptoms and perioperative ischemias were collected, and a logistic regression analysis was performed. A total of 100 hemispheres in 50 MMA patients (36 women, 14 men) were included. Using the Berlin Grading System, 2 (2.8%) of 71 symptomatic hemispheres were categorized as grade I, 14 (19.7%) as grade II, and 55 (77.5%) as grade III. The 29 asymptomatic hemispheres were characterized as grade I in 7 (24.1%) hemispheres, grade II in 12 (41.4%), and grade III in 10 (34.5%) hemispheres. Berlin grades were independent factors for identifying hemispheres as symptomatic and higher grades correlated with increasing proportion of symptomatic hemispheres (p < 0.01). The Suzuki grading did not correlate with preoperative symptoms (p = 0.26). Perioperative ischemic complications occurred in 8 of 88 operated hemispheres. Overall, complications did not occur in any of the grade I hemispheres, but in 9.1% (n = 2 of 22) and 9.8% (n = 6 of 61) of grade II and III hemispheres, respectively. In this study, we validated the Berlin Grading System with the use of [15O]H2O PET for CVRC as it could stratify preoperative symptomatology. Furthermore, we highlighted its relevance for predicting perioperative ischemic complications.
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Affiliation(s)
- R Mertens
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Kersting
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C Lange
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C Furth
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - D Beyaztas
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - P Truckenmueller
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - L Moedl
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - E D Spruenken
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - M Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - P Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
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24
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Goto I, Okamoto R, Sato Y, Tsuji A, Tanigawa T, Dohi K. Moyamoya Disease Complicating Ebstein's Anomaly. Intern Med 2022; 61:3683-3686. [PMID: 35569986 PMCID: PMC9841108 DOI: 10.2169/internalmedicine.9516-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Ebstein's anomaly is an uncommon congenital disorder affecting the tricuspid valve. We herein report a 38-year-old woman who experienced consciousness and sensory disturbance during treatment for heart failure caused by Ebstein's anomaly. Urgent magnetic resonance imaging and cerebral angiography demonstrated acute cerebral infarction and internal carotid artery obstruction with the development of collateral arteries. We diagnosed her with multiple cerebral infarctions due to moyamoya disease. Ebstein's anomaly concomitant with moyamoya disease is extremely rare. However, we should consider the possibility of this rare but important concurrence when treating patients with heart failure due to Ebstein's anomaly to avoid excessive diuresis and vasodilation and irreversible brain injury.
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Affiliation(s)
- Itaru Goto
- Department of Cardiology, Matsusaka Chuo General Hospital, Japan
| | - Ryuji Okamoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
- Regional Medical Support Center, Mie University Hospital, Japan
| | - Yu Sato
- Department of Neurosurgery, Matsusaka Chuo General Hospital, Japan
| | - Akihiro Tsuji
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Takashi Tanigawa
- Department of Cardiology, Matsusaka Chuo General Hospital, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
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25
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He Q, Ge P, Ye X, Liu X, Wang J, Wang R, Zhang Y, Zhang D, Zhao J. Hyperhomocysteinemia Is a Predictor for Poor Postoperative Angiogenesis in Adult Patients With Moyamoya Disease. Front Neurol 2022; 13:902474. [PMID: 35720075 PMCID: PMC9201052 DOI: 10.3389/fneur.2022.902474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Purposes The risk factors of poor postoperative angiogenesis in moyamoya disease (MMD) patients remain unknown. We aimed to investigate the association between hyperhomocysteinemia (HHcy) and postoperative angiogenesis of adult patients with MMD. Methods A total of 138 adult patients with MMD were prospectively recruited from July 1 to December 31, 2019. After excluding 10 patients accepting conservative therapy and 77 individuals without postoperative digital subtraction angiography (DSA), all 51 MMD patients were enrolled, and 28 patients received bilateral operations separately. Patients were grouped according to postoperative angiogenesis and HHcy presentation, respectively. Clinical data and laboratory examinations were compared. Potential risk factors were evaluated by univariate and multivariate logistic regression analysis. Nomogram was further performed. The biological functions of homocysteine (Hcy) were explored in vitro. Results Comparing to the normal, patients with poor postoperative angiogenesis were higher in serum Hcy (p = 0.004), HHcy ratio (p = 0.011), creatinine (Cr) (p < 0.001), uric acid (UA) (p = 0.036), Triglyceride (p = 0.001), high-density lipoprotein cholesterol (HDL-C) (p = 0.001), low-density lipoprotein cholesterol (LDL-C) (p = 0.009), ApoA (p = 0.022), apolipoprotein B (ApoB) (p = 0.013). Furthermore, HHcy was more common in men (p = 0.003) than women. Logistic analysis results showed that Hcy (OR = 0.817, 95% CI = 0.707–0.944, p = 0.006) was an independent risk factor. HHcy and Cr were significantly associated with poor postoperative angiogenesis in MMD patients. Further, Hcy could inhibit the proliferation, migration, and tube formation of human brain microvascular endothelial cells (HBMECs), which can be reversed by vascular endothelial growth factor (VEGF). Conclusion The HHcy was significantly correlated with poor postoperative angiogenesis in adult patients with MMD. Hcy significantly inhibits HBMECs proliferation, migration, and tube formation. Furthermore, VEGF could reverse the inhibition effect induced by Hcy. Lowering the level of Hcy may be beneficial for postoperative MMD patients. Focusing on the pathophysiology and mechanism of HHcy might help to guide postoperative clinical management.
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Affiliation(s)
- Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- *Correspondence: Peicong Ge
| | - Xun Ye
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingju Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jia Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Dong Zhang
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Jizong Zhao
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26
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Xu R, Xie ME, Feghali J, Yang W, Kim J, Lee R, Liew J, Tamargo RJ, Huang J. Revascularization of Hemorrhagic Moyamoya Disease in a North American Cohort: The Role of Timing in Perioperative and Long-Term Outcomes. Neurosurgery 2022; 90:434-440. [DOI: 10.1227/neu.0000000000001850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023] Open
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27
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Connolly F, Alsolivany J, Czabanka M, Vajkoczy P, Valdueza JM, Röhl JE, Siebert E, Danyel LA. Blood volume flow in the superficial temporal artery assessed by duplex sonography: predicting extracranial-intracranial bypass patency in moyamoya disease. J Neurosurg 2021; 135:1666-1673. [PMID: 33836503 DOI: 10.3171/2020.9.jns202709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery is an important therapy for symptomatic moyamoya disease. Its success depends on bypass function, which may be impaired by primary or secondary bypass insufficiency. Catheter angiography is the current gold standard to assess bypass function, whereas the diagnostic value of ultrasonography (US) has not been systematically analyzed so far. METHODS The authors analyzed 50 STA-MCA bypasses in 39 patients (age 45 ± 14 years [mean ± SD]; 26 female, 13 male). Bypass patency was evaluated by catheter angiography, which was performed within 24 hours after US. The collateral circulation through the bypass was classified into 4 types as follows: the bypass supplies more than two-thirds (type A); between one-third and two-thirds (type B); or less than one-third (type C) of the MCA territory; or there is bypass occlusion (type D). The authors assessed the mean blood flow velocity (BFV), the blood volume flow (BVF), and the pulsatility index (PI) in the external carotid artery and STA by duplex sonography. Additionally, they analyzed the flow direction of the MCA by transcranial color-coded sonography. US findings were compared between bypasses with higher (types A and B) and lower (types C and D) capacity. RESULTS Catheter angiography revealed high STA-MCA bypass capacity in 35 cases (type A: n = 22, type B: n = 13), whereas low bypass capacity was noted in the remaining 15 cases (type C: n = 12, type D: n = 3). The BVF values in the STA were 60 ± 28 ml/min (range 4-121 ml/min) in the former and 12 ± 4 ml/min (range 6-18 ml/min) in the latter group (p < 0.0001). Corresponding values of mean BFV and PI were 57 ± 21 cm/sec (range 16-100 cm/sec) versus 22 ± 8 cm/sec (range 10-38 cm/sec) (p < 0.0001) and 0.8 ± 0.2 (range 0.4-1.3) versus 1.4 ± 0.5 (range 0.5-2.4) (p < 0.0001), respectively. Differences in the external carotid artery were less distinct: BVF 217 ± 71 ml/min (range 110-425 ml/min) versus 151 ± 41 ml/min (range 87-229 ml/min) (p = 0.001); mean BFV 47 ± 17 cm/sec (range 24-108 cm/sec) versus 40 ± 7 cm/sec (range 26-50 cm/sec) (p = 0.15); PI 1.5 ± 0.4 (range 1.0-2.5) versus 1.9 ± 0.4 (range 1.2-2.6) (p = 0.009). A retrograde blood flow in the MCA was found in 14 cases (9 in the M1 and M2 segment; 5 in the M2 segment alone), and all of them showed a good bypass function (type A, n = 10; type B, n = 4). The best parameter (cutoff value) to distinguish bypasses with higher capacity from bypasses with lower capacity was a BVF in the STA ≥ 21 ml/min (sensitivity 100%, negative predictive value 100%, specificity 91%, positive predictive value 83%). CONCLUSIONS Duplex sonography is a suitable diagnostic tool to assess STA-MCA bypass function in moyamoya disease. Hemodynamic monitoring of the STA by US provides an excellent predictor of bypass patency.
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Affiliation(s)
| | | | | | | | - Jose M Valdueza
- 3Neurological Center, Segeberger Kliniken, Schleswig-Holstein, Bad Segeberg; and
| | | | - Eberhard Siebert
- 4Institute of Neuroradiology, University Hospital Charité, Berlin, Germany
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28
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Nathal E, Serrano-Rubio A, Maciel E, Arauz A. Moyamoya disease in Mexico: our experience. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:603-610. [PMID: 34654535 DOI: 10.1016/j.nrleng.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/13/2018] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Moyamoya disease (MD) is a progressive, occlusive disease of the arteries of the anterior cerebral circulation that may cause ischaemia or haemorrhage. Patient management aims to prevent new cerebrovascular events through surgical revascularisation and/or pharmacological treatment. MATERIALS AND METHODS We studied a series of 17 patients with MD (n = 14) or moyamoya syndrome (MS; n = 3), who were evaluated between January 1989 and December 2016; 11 patients were women and 6 were men. Thirteen patients had definitive MD (76%), one had unilateral MD (5.2%), and 3 had MS (18%). The condition manifested as intraparenchymal haemorrhage (in 35.2% of patients), brain ischaemia (29.4%), subarachnoid haemorrhage (17.6%), seizures (11.7%), and headache with no associated haemorrhage (1 patient). RESULTS Ten patients (58.8%) underwent revascularisation and 7 (41.2%) received pharmacological treatment. All patients were evaluated with the modified Rankin Scale (mRs) at admission and at the last consultation; mRs scores were significantly lower in the group undergoing surgery (P < .04). During follow-up, none of the patients undergoing revascularisation experienced recurrences, whereas 2 patients receiving pharmacological treatment did experience a new vascular event (one ischaemic and one haemorrhagic) (P < .05). No significant differences were observed between the treatment outcomes of different revascularisation techniques. CONCLUSIONS Although our population has different demographic characteristics from those of other non-Asian populations, ours is the largest published series of Hispanic individuals with MD. Our results support the use of revascularisation procedures to improve these patients' neurological status and to prevent new cerebrovascular events.
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Affiliation(s)
- E Nathal
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico.
| | - A Serrano-Rubio
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - E Maciel
- Escuela de Medicina, Instituto Tecnológico de Monterrey Campus Guadalajara, Guadalajara, Mexico
| | - A Arauz
- Departamento de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudadde México, Mexico
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29
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Mertens R, Graupera M, Gerhardt H, Bersano A, Tournier-Lasserve E, Mensah MA, Mundlos S, Vajkoczy P. The Genetic Basis of Moyamoya Disease. Transl Stroke Res 2021; 13:25-45. [PMID: 34529262 PMCID: PMC8766392 DOI: 10.1007/s12975-021-00940-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive spontaneous bilateral occlusion of the intracranial internal cerebral arteries (ICA) and their major branches with compensatory capillary collaterals resembling a “puff of smoke” (Japanese: Moyamoya) on cerebral angiography. These pathological alterations of the vessels are called Moyamoya arteriopathy or vasculopathy and a further distinction is made between primary and secondary MMD. Clinical presentation depends on age and population, with hemorrhage and ischemic infarcts in particular leading to severe neurological dysfunction or even death. Although the diagnostic suspicion can be posed by MRA or CTA, cerebral angiography is mandatory for diagnostic confirmation. Since no therapy to limit the stenotic lesions or the development of a collateral network is available, the only treatment established so far is surgical revascularization. The pathophysiology still remains unknown. Due to the early age of onset, familial cases and the variable incidence rate between different ethnic groups, the focus was put on genetic aspects early on. Several genetic risk loci as well as individual risk genes have been reported; however, few of them could be replicated in independent series. Linkage studies revealed linkage to the 17q25 locus. Multiple studies on the association of SNPs and MMD have been conducted, mainly focussing on the endothelium, smooth muscle cells, cytokines and growth factors. A variant of the RNF213 gene was shown to be strongly associated with MMD with a founder effect in the East Asian population. Although it is unknown how mutations in the RNF213 gene, encoding for a ubiquitously expressed 591 kDa cytosolic protein, lead to clinical features of MMD, RNF213 has been confirmed as a susceptibility gene in several studies with a gene dosage-dependent clinical phenotype, allowing preventive screening and possibly the development of new therapeutic approaches. This review focuses on the genetic basis of primary MMD only.
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Affiliation(s)
- R Mertens
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin, Germany
| | - M Graupera
- Vascular Biology and Signalling Group, ProCURE, Oncobell Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Barcelona, Spain
| | - H Gerhardt
- Integrative Vascular Biology Laboratory, Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - A Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - E Tournier-Lasserve
- Department of Genetics, NeuroDiderot, Lariboisière Hospital and INSERM UMR-1141, Paris-Diderot University, Paris, France
| | - M A Mensah
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Genetics and Human Genetics, Berlin, Germany.,BIH Biomedical Innovation Academy, Digital Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Mundlos
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Genetics and Human Genetics, Berlin, Germany.,Max Planck Institute for Molecular Genetics, RG Development & Disease, Berlin, Germany
| | - P Vajkoczy
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin, Germany.
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30
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Han Z, Li L, Liu P, Huang Y, Zhang S, Li G, Li F, Zhao H, Tao Z, Wang R, Ma Q, Luo Y. Metabolic Adjustments by LncRNAs in Peripheral Neutrophils Partly Account for the Complete Compensation of Asymptomatic MMD Patients. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 19:306-317. [PMID: 32552656 DOI: 10.2174/1871527319666200618150827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Due to the recent development of non-invasive examinations, more asymptomatic patients with Moyamoya Disease (MMD) have been diagnosed than ever. However, its underlying molecular mechanisms and clinical intervention guidelines are all still obscure. METHODS Microarray was used to explore those differentially expressed mRNAs and lncRNAs in peripheral neutrophils of asymptomatic MMD patients. Then enrichment analyses based on Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) for those differentially expressed mRNAs and lncRNA associated mRNAs were performed for underlying molecular mechanisms. RESULTS Here, we identified a total of 2824 differentially expressed lncRNAs and 522 differentially expressed mRNAs (fold change > 2 and P<0.05) in peripheral neutrophils of asymptomatic MMD patients, compared with healthy controls. Then enrichment analyses based on GO and KEGG showed that the neighboring protein-coding mRNAs of those up-regulated and down-regulated lncRNAs were mainly involved in distinct metabolic processes respectively, which may act as a complementary response to insufficient blood supplies in MMD. Further enrichment analyses of those differentially expressed mRNAs preferentially listed essential physiological processes such as peptide cross-linking, chromatin assembly among others. Moreover, altered mRNAs also revealed to be enriched in renin secretion, platelet activation, inflammation and others. CONCLUSION We demonstrated for the first time that metabolic adjustments by dysregulated lncRNAs in peripheral neutrophils might partially account for the complete compensation of asymptomatic MMD patients. In addition, more attention should be paid on renin secretion and platelet activation in order to better understand the pathogenesis and guide clinical intervention for asymptomatic MMDs.
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Affiliation(s)
- Ziping Han
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lingzhi Li
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ping Liu
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuyou Huang
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sijia Zhang
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guangwen Li
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fangfang Li
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiping Zhao
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Zhen Tao
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Rongliang Wang
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yumin Luo
- Institute of Cerebrovascular Diseases Research, Department of Neurology, and Department of Neurosurgery of Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
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Clinical Management of Moyamoya Patients. J Clin Med 2021; 10:jcm10163628. [PMID: 34441923 PMCID: PMC8397113 DOI: 10.3390/jcm10163628] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 01/01/2023] Open
Abstract
Moyamoya angiopathy (MMA) is a peculiar cerebrovascular condition characterized by progressive steno-occlusion of the terminal part of the internal carotid arteries (ICAs) and their proximal branches, associated with the development of a network of fragile collateral vessels at the base of the brain. The diagnosis is essentially made by radiological angiographic techniques. MMA is often idiopathic (moyamoya disease-MMD); conversely, it can be associated with acquired or hereditary conditions (moyamoya Syndrome-MMS); however, the pathophysiology underlying either MMD or MMS has not been fully elucidated to date, and this poor knowledge reflects uncertainties and heterogeneity in patient management. MMD and MMS also have similar clinical expressions, including, above all, ischemic and hemorrhagic strokes, then headaches, seizures, cognitive impairment, and movement disorders. The available treatment strategies are currently shared between idiopathic MMD and MMS, including pharmacological and surgical stroke prevention treatments and symptomatic drugs. No pharmacological treatment able to reverse the progressive disappearance of the ICAs has been found to date in both idiopathic and syndromic cases. Antithrombotic agents are usually prescribed in ischemic MMA, although the coexisting hemorrhagic risk should be considered. Surgical revascularization techniques, which are currently the best available treatment in symptomatic MMA, are associated with good long-term outcomes and reduced ischemic and hemorrhagic risks. Given the lack of dedicated randomized clinical trials, current treatment is mainly based on observational studies and physicians’ and surgeons’ expertise.
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Zhang X, Xiao W, Zhang Q, Xia D, Gao P, Su J, Yang H, Gao X, Ni W, Lei Y, Gu Y. Progression in Moyamoya Disease: Clinical Feature, Neuroimaging Evaluation and Treatment. Curr Neuropharmacol 2021; 20:292-308. [PMID: 34279201 PMCID: PMC9413783 DOI: 10.2174/1570159x19666210716114016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/08/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic cerebrovascular disease characterized by progressive stenosis of the arteries of the circle of Willis, with the formation of collateral vascular network at the base of the brain. Its clinical manifestations are complicated. Numerous studies have attempted to clarify the clinical features of MMD, including its epidemiology, genetic characteristics, and pathophysiology. With the development of neuroimaging techniques, various neuroimaging modalities with different advantages have deepened the understanding of MMD in terms of structural, functional, spatial, and temporal dimensions. At present, the main treatment for MMD focuses on neurological protection, cerebral blood flow reconstruction, and neurological rehabilitation, such as pharmacological treatment, surgical revascularization, and cognitive rehabilitation. In this review, we discuss recent progress in understanding the clinical features, in the neuroimaging evaluation and treatment of MMD.
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Affiliation(s)
- Xin Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Weiping Xiao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Qing Zhang
- Department of Nursing, Huashan Hospital North, Fudan University, China
| | - Ding Xia
- Department of Radiology, Huashan Hospital North, Fudan University, China
| | - Peng Gao
- Department of Radiology, Huashan Hospital North, Fudan University, China
| | - Jiabin Su
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Heng Yang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Xinjie Gao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Wei Ni
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Yu Lei
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, China
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Shlobin NA, Hoffman SC, Clark JR, Du RY, Lam S. Clinical Usefulness of Genetic Testing For Patients with Moyamoya Disease: A Systematic Review. World Neurosurg 2021; 152:198-205.e1. [PMID: 34098142 DOI: 10.1016/j.wneu.2021.05.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The effect of genetic factors on presentation and outcomes of moyamoya disease (MMD) is unclear. We aimed to examine differences in presentation of MMD by genetic variant, delineate the influence of genetic factors on outcomes, and characterize the applicability of genetic testing to management. METHODS A systematic review was conducted using the PubMed, Embase, and Scopus databases. Title/abstract screening, full-text screening, and data extraction were conducted. RESULTS Of 1329 articles, 12 were included. Genes included RNF213 (ring finger protein 213), VEGF (vascular endothelial growth factor), and soluble VEGR receptor (sVEGFR) 1 and 2. Patients heterozygous and homozygous for the p.R1480K variant of RNF213 had younger age of onset; were more frequently familial, had posterior cerebral artery involvement, had bilateral lesions; and were more likely to present with cerebral infarction or transient ischemic attack. The heterozygous p.4810K variant is associated with improved postoperative collateral formation. Stroke recurrence, stroke-free survival, neurologic status, and functional condition after surgery are not associated with the p.4180K genotype. Patients homozygous for p.4180K more frequently experience long-term cognitive impairment. Patients with the C/C genotype of VEGF 2634 or decreased sVEGFR-1 and sVEGFR levels postoperatively had greater postoperative collateral formation. CONCLUSIONS Genetic factors correlate with MMD presentation including age of onset, severity, and symptoms, and angiographic and clinical outcomes after surgery. Incorporation of genetic testing panels into practice may allow for risk stratification, management, and follow-up of children and adults with MMD. However, future studies are necessary to validate the usefulness of genetic testing for MMD before this situation occurs.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Steven C Hoffman
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Jeffrey R Clark
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Rebecca Y Du
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Sandi Lam
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, Illinois, USA.
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Wan J, Ling W, Zhengshan Z, Xianbo Z, Lian D, Kai W. Association of HLA-DQA2 and HLA-B With Moyamoya Disease in the Chinese Han Population. NEUROLOGY-GENETICS 2021; 7:e592. [PMID: 34095496 PMCID: PMC8176556 DOI: 10.1212/nxg.0000000000000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022]
Abstract
Objective An HLA imputation was conducted to explore the relationship between HLA and patients with moyamoya disease (MMD) in the Chinese Han population. Methods In this study, we performed an association analysis of the major histocompatibility complex region in 2,786 individuals of Chinese Han ancestry (2,031 controls and 755 patients with MMD), through a widely used HLA imputation method. Results We identified that the variant rs3129731 (odds ratio [OR] = 1.79, p = 3.69 × 10−16) located between the MTCO3P1 and HLA-DQA2 is a major genetic risk factor for MMD. In addition to this variant, found in the conditional association analysis, we also detected another independent signal, rs1071817 (OR = 0.62, p = 1.20 × 10−11), in HLA-B. Conclusions Our research suggests that the genetic polymorphism of HLA-DQA2 and HLA-B could be a genetic predisposing factor for MMD in Chinese Han. This may provide some evidence for further HLA-related studies of patients with MMD of Chinese Han ethnicity and indicates that MMD is an immune-related disease.
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Affiliation(s)
- Jiang Wan
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
| | - Wei Ling
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
| | - Zhang Zhengshan
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
| | - Zuo Xianbo
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
| | - Duan Lian
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
| | - Wang Kai
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
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Gurung S, Gaire S, Bajracharya A, Paudel AK, Budhathoki P. Moyamoya Disease in an adult female from Nepal: A case report. Ann Med Surg (Lond) 2021; 66:102424. [PMID: 34123376 PMCID: PMC8175286 DOI: 10.1016/j.amsu.2021.102424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Moyamoya is a progressive vasoocclusive disease of large intracranial arteries with characteristic collaterals formation. It has a bimodal distribution and more frequent in females compared to males. CASE PRESENTATION We present a case of 38 years female who presented with a loss of consciousness following headache. She was investigated with a head CT, cerebral angiogram, and digital subtraction angiography which led to a diagnosis of Moyamoya disease. She was treated conservatively and scheduled for follow-up. CLINICAL DISCUSSION Although ischemic attacks are the common presenting symptoms in cases of Moyamoya disease, hemorrhagic forms are seen too especially among adults compared to children. Identifying Moyamoya disease can significantly affect the treatment options and give insight into managing the chronic nature of the disease to both the physicians and patients. CONCLUSION This case highlights the importance of searching for underlying cause in a young female presenting with intracranial haemorrhage for the first time and keeping Moyamoya disease as a differential.
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Affiliation(s)
- Suja Gurung
- Intensive Care Unit (ICU), Dirghayu Guru Hospital and Research Centre, Kathmandu, 44600, Nepal
| | - Suman Gaire
- Department of Emergency Medicine, Palpa Hospital, Palpa, 32500, Nepal
| | | | | | - Pravash Budhathoki
- Department of Emergency Medicine and General Practice, Dr. Iwamura Memorial Hospital, Bhaktapur, 44800, Nepal
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Srinivasan HL, Hausman-Kedem M, Smith ER, Constantini S, Roth J. Current trends in pediatric moyamoya: a survey of international practitioners. Childs Nerv Syst 2021; 37:2011-2023. [PMID: 33694129 DOI: 10.1007/s00381-021-05074-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Moyamoya angiopathy (MM) is a chronic, progressive steno-occlusive arteriopathy of the distal internal carotid artery and its proximal branches. MM is recognized as a shared end-pathway common to a broad range of inciting pathologies, suggesting that tailored management is important. Pediatric MM differs from MM in adults. Currently, there are many uncertainties and controversies regarding the diagnosis and management of children with MM. Hence, we conducted an international survey to identify the contemporary management trends followed worldwide. METHODS A survey relating to lifestyle modifications, medical management, diagnosis, surgical management, and follow-up for pediatric MM was circulated across web-based platforms, through various international pediatric neurological and neurosurgical societies. Data collected included geographic region of practice, experience, responses to questions, and comments. RESULTS One hundred twenty-seven responses were evaluated (104 neurosurgeons and 23 neurologists, from 32 countries, across 6 continents). We found wide variations in the recommendations for management and lifestyle modification, with significant differences between regions of practice. Eighty percent recommend restrictions on physical activity, particularly for symptomatic and non-operated patients. Eighty-four percent prescribe aspirin. Sixty-five percent perform indirect revascularization. Seventy-eight percent recommend performing a staged surgery for bilateral MM. Only 26% perform acetazolamide challenge SPECT to evaluate brain perfusion. Only 15% of responders were from highly experienced centers. CONCLUSION This survey reflects the contemporary trends in management of pediatric MM, while highlighting the heterogeneity in the management approach of these patients. There is a need for multicenter, international studies to evaluate the safety, efficacy, and long-term outcome of various aspects of treatment of these patients.
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Affiliation(s)
- Harishchandra Lalgudi Srinivasan
- Pediatric Neurosurgery Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Moran Hausman-Kedem
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward R Smith
- Pediatric Cerebrovascular Surgery, Pediatric Neurosurgery, Children's Hospital Boston/Harvard Medical School, Boston, MA, USA
| | - Shlomi Constantini
- Pediatric Neurosurgery Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Roth
- Pediatric Neurosurgery Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Characteristics of Moyamoya Disease in the Older Population: Is It Possible to Define a Typical Presentation and Optimal Therapeutical Management? J Clin Med 2021; 10:jcm10112287. [PMID: 34070336 PMCID: PMC8197522 DOI: 10.3390/jcm10112287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 12/17/2022] Open
Abstract
Whereas several studies have been so far presented about the surgical outcomes in terms of mortality and perioperative complications for elderly patients submitted to neurosurgical treatments, the management of elderly moyamoya patients is unclear. This review aims to explore the available data about the clinical manifestation, characteristics, and outcome after surgery of older patients with moyamoya arteriopathy (MA). We found only two articles strictly concerning elderly patients with MA. We have also evaluated other reported adult series of moyamoya patients, including elderly cases in their analysis. Patients with MA above 50 years old may be considered a peculiar subset in which patients are often presenting with ischemic symptoms and a higher Suzuki grade. Conservative treatment may be proposed in asymptomatic or stable cases due to their fragility and possible increase of post-operative complications, while the best surgical options in symptomatic cases are still under investigation, although we believe that a minimal invasive superficial temporal artery—middle cerebral artery bypass could be considered the treatment of choice for the immediate effect on brain perfusion with a limited rate of post-operative complications.
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Ye F, Wang T, Yin H, Li J, Li H, Guo T, Zhang X, Yang T, Jie L, Wu X, Li Q, Sheng W. Development and Validation of a Nomogram to Predict the Individual Future Stroke Risk for Adult Patients With Moyamoya Disease: A Multicenter Retrospective Cohort Study in China. Front Neurol 2021; 12:669025. [PMID: 34054709 PMCID: PMC8155507 DOI: 10.3389/fneur.2021.669025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Studies exploring the predictive performance of major risk factors associated with future stroke events are insufficient, and a useful tool to predict individual risk is not available. Therefore, personalized advice for preventing future stroke in patients with moyamoya disease (MMD) cannot provide evidence-based recommendations. The aim of this study was to develop a novel nomogram with reliable validity to predict the individual risk of future stroke for adult MMD patients. Methods: This study included 450 patients from seven medical centers between January 2013 and December 2018. Follow-ups were performed via clinical visits and/or telephone interviews from initial discharge to December 2019. The cohort was randomly assigned to a training set (2/3, n = 300) for nomogram development and a test set (1/3, n = 150) for external validation. The Kaplan-Meier analyses and receiver operating characteristic (ROC) curves were applied to assess the clinical benefits of this nomogram. Results: Diabetes mellitus, a family history of MMD, a past history of stroke or transient ischemic attack, clinical manifestation, and treatment were identified as major risk factors via the least absolute shrinkage and selection operator (LASSO) method. A nomogram including these predictors was established via a multivariate Cox regression model, which displayed excellent discrimination [Harrell's concordance index (C-index), 0.85; 95% confidence interval (CI): 0.75–0.96] and calibration. In the external validation, the nomogram was found to have good discrimination (C-index, 0.81; 95% CI: 0.68–0.94) and calibration. In the subgroup analysis, this predictive nomogram also showed great performance in both ischemic-type (C-index, 0.90; 95% CI: 0.77–1.00) and hemorrhagic-type MMD (C-index, 0.72; 95% CI: 0.61–0.83). Furthermore, the nomogram was shown to have potential in clinical practice through Kaplan-Meier analyses and ROC curves. Conclusions: We developed a novel nomogram incorporating several clinical characteristics with relatively good accuracy, which may have considerable potential for evaluating individual future stroke risk and providing useful management recommendations for adult patients with MMD in clinical practice.
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Affiliation(s)
- Fei Ye
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tianzhu Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haoyuan Yin
- Department of Neurosurgery, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Jiaoxing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haiyan Li
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tongli Guo
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiong Zhang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingting Yang
- Department of Neurology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liang Jie
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxin Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenli Sheng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Alkhaibary A, Almutairi OT, Elarjani T, Alnefaie N, Alhussinan MA, Bafaquh M, Alturki AY. The Top-100 most cited articles on Moyamoya disease: A bibliometric analysis. J Cerebrovasc Endovasc Neurosurg 2021; 23:85-98. [PMID: 33975427 PMCID: PMC8256026 DOI: 10.7461/jcen.2021.e2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Moyamoya disease (MMD) is a progressive steno-occlusive cerebrovascular phenomenon with unknown pathogenesis. Considering the abundance of articles addressing Moyamoya disease, a detailed analysis concerning the publication trends is of paramount importance. The aim of the study is to report the current knowledge of the top-100 most cited articles on Moyamoya disease in the literature. METHODS A non-time restricted keyword-based search was performed in June 2020 using the Scopus database. The search keywords included the following: "Moyamoya", "Moyamoya disease", and "Moyamoya syndrome". The search result was used to rank the articles based on their citation count. The top-100 most-cited articles were obtained and classified into seven categories. RESULTS A total of 3,543 articles on Moyamoya disease were published between 1955 and 2020. The Top-100 articles were published between 1977 and 2016 with a total of 16,119 citations, per year, and 7.23% rate of self-citation. The 1990s was the most productive decade (N=42). The most contributing country to the list was Japan (N=60). Stroke was the most active journal (N=23). Houkin, K., a Japanese neurosurgeon, was the most prolific author (N=15). CONCLUSIONS Moyamoya disease has been extensively investigated in the literature throughout the years. The majority of articles published in the literature were addressing the surgical management and clinical outcome. Authors from neurosurgical backgrounds were the most active contributors to the field of Moyamoya disease.
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Affiliation(s)
- Ali Alkhaibary
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Othman T Almutairi
- Department of Adult Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Turki Elarjani
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Nada Alnefaie
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Mohammed Bafaquh
- Neurocritical Care Division, Critical Care Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Y Alturki
- Department of Adult Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.,Neurocritical Care Division, Critical Care Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Sun Y, Zhou G, Feng J, Chen L, Liu G, Wang J, Wang Q, Yu J, Yang X, Yang Z, Gao P, Wang S, Zhan S. Incidence and prevalence of moyamoya disease in urban China: a nationwide retrospective cohort study. Stroke Vasc Neurol 2021; 6:615-623. [PMID: 33941642 PMCID: PMC8717778 DOI: 10.1136/svn-2021-000909] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Moyamoya disease (MMD) is an increasingly recognised cause of stroke, mainly described in East Asia. China is the largest nation in Asia, but few studies reported the epidemiology of MMD, especially at a national level. We aimed to estimate the incidence and prevalence of MMD in China. METHODS We performed a population-based study using data from the national databases of Urban Basic Medical Insurance between 2013 and 2016, covering approximately 0.50 billion individuals. MMD cases were identified by diagnostic code (International Classification of Diseases, 10th Revision I67.5) or related diagnostic text. RESULTS A total of 1987 MMD patients (mean age 44.45±14.30 years, female-to-male ratio 1.12) were identified, representing a national crude incidence of 0.59 (95% CI: 0.49 to 0.68) and a prevalence of 1.01 (95% CI: 0.81 to 1.21) per 100 000 person-years in 2016. Rates were higher in females than in males for the incidence (0.66 vs 0.52) and prevalence (1.05 vs 0.90). And the age-specific rates showed a bimodal distribution, with the highest peak in middle-aged group and the second peak in child group. CONCLUSIONS Our results confirm that MMD is relatively common in East Asians, but the rates in China were lower than those in other East Asian countries such as Japan and Korea. The unique epidemiological features, including a relatively weak female predominance and a shift in the highest peak of incidence from children to adults, revealed new sight into MMD. Further research is expected to explore the potential pathogenesis of MMD.
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Affiliation(s)
- Yixin Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Guoyu Zhou
- Department of Geriatric Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Jingnan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Guozhen Liu
- Peking University Health Information Technology Co. Ltd, Beijing, China
| | - Jinxi Wang
- Beijing Healthcom Data Technology Co. Ltd, Beijing, China
| | - Qingliang Wang
- Department of Medical Affairs, Qilu Hospital of Shandong University, Jinan, China
| | - Junyou Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Xiwang Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Zheng Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
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Patients with Moyamoya Vasculopathy Evaluated at a Single-Center in The Netherlands; Clinical Presentation and Outcome. J Clin Med 2021; 10:jcm10091898. [PMID: 33925657 PMCID: PMC8124614 DOI: 10.3390/jcm10091898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022] Open
Abstract
Information on presentation and outcome of moyamoya vasculopathy (MMV) in European countries is limited. We investigated patient characteristics, treatment and outcome of patients with MMV. We retrieved patient characteristics and treatment information and determined functional outcome (modified Rankin Score (mRS); type of school/work) by structured telephone interviews. We performed uni- and multivariable logistic regression analysis to determine predictors of poor outcome. We included 64 patients with bilateral MMV. In children (31 patients), median age was 5 years (interquartile range (IQR) 2-11) and in adults (33 patients), it was 33 years (IQR 28-41). Predominant mode of presentation was ischemia (children 84%; adults 88%). Modified Rankin Scale (mRS) at presentation was ≤2 in 74%. Revascularization was performed in 42 patients (23 children). Median follow-up time was 46 months (IQR 26-90). During this period, 16 patients had recurrent stroke(s) and four patients died. In 73% of the patients (83% surgical group; 55% medically treated group), mRS was ≤2; 46% were able to return to regular school or work, of whom only 41% were on the same level. Univariable analysis revealed that surgical treatment was associated with lower odds of poor outcome ((mRS ≥ 3), OR 0.24; p = 0.017). This association was no longer statistically significant (OR 3.47; p = 0.067) in the multivariable model, including age and diagnosis (moyamoya disease or moyamoya syndrome). In this cohort of patients with MMV who presented in a single European center, a large proportion had good functional outcome. Nevertheless, less than half were able to attend regular school or were able to work at their previous level, indicating a large impact of the disease on their life.
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Vranic JE, Hartman JB, Mossa-Basha M. High-Resolution Magnetic Resonance Vessel Wall Imaging for the Evaluation of Intracranial Vascular Pathology. Neuroimaging Clin N Am 2021; 31:223-233. [PMID: 33902876 DOI: 10.1016/j.nic.2021.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Intracranial vessel wall imaging (IVWI) is an advanced MR imaging technique that allows for direct visualization of the walls of intracranial blood vessels and detection of subtle pathologic vessel wall changes before they become apparent on conventional luminal imaging. When performed correctly, IVWI can increase diagnostic confidence, aid in the differentiation of intracranial vasculopathies, and assist in patient risk stratification and prognostication. This review covers the essential technical underpinnings of IVWI and presents emerging clinical research highlighting its utility for the evaluation of multiple intracranial vascular pathologies.
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Affiliation(s)
- Justin E Vranic
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 2, Room 273A, 55 Fruit Street, Boston, MA 02114, USA.
| | - Jason B Hartman
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Box 357115, Seattle, WA 98195, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Box 357115, Seattle, WA 98195, USA
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Failures in Revascularization for Pediatric Moyamoya Disease and Syndrome: A Scoping Review. World Neurosurg 2021; 149:204-214.e1. [PMID: 33618047 DOI: 10.1016/j.wneu.2021.02.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Moyamoya disease (MMD) and moyamoya syndrome (MMS) are a rare cause of stroke commonly managed surgically. We conducted a scoping review to identify the current scope of the literature regarding factors associated with failure of revascularization surgery for MMD and MMS in pediatric patients and to catalyze future research. METHODS A scoping review was conducted to explore failures of revascularization surgery for MMD and MMS in pediatric patients using the PubMed, Embase, and Scopus databases. Titles and abstracts returned from searches were screened for full-text review. Studies meeting inclusion criteria were reviewed in full, and relevant data were extracted. RESULTS Of 2450 resultant articles, 15 were included. Angiographic outcomes were reported for 900 hemispheres, of which 442 (49.1%) were denoted as Matsushima grade A, 299 (33.2%) as Matsushima grade B, and 159 (17.7%) as Matsushima grade C. Patients with MMS had poorer angiographic outcomes than did patients with MMD. Patients with poor neovascularization had a greater degree of moyamoya vessels on follow-up angiogram. Suzuki stage was not associated with angiographic outcome in individual patients. Angiographic outcomes differed by surgical approach and were not associated with clinical outcomes. Literature identifying factors was sparse. CONCLUSIONS The existing literature indicates that factors such as cause, degree of moyamoya vessels, and surgical approach may affect the likelihood of Matsushima grade C revascularization in pediatric patients with MMD and MMS. Future studies are necessary to definitively elucidate factors associated with failure of revascularization surgery for pediatric MMD.
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Zhang X, Yin L, Jia X, Zhang Y, Liu T, Zhang L. iTRAQ-based Quantitative Proteomic Analysis of Dural Tissues Reveals Upregulated Haptoglobin to be a Potential Biomarker of Moyamoya Disease. CURR PROTEOMICS 2021. [DOI: 10.2174/1570164617666191210103652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Moyamoya Disease (MMD) is a rare cerebrovascular disease with a high rate
of disability and mortality. Immune reactions have been implicated in the pathogenesis of MMD, however,
the underlying mechanism is still unclear.
Objective:
To identify proteins related to MMD specially involved in the immunogenesis, we performed
a proteomic study.
Methods:
In this work, dural tissues or plasma from 98 patients with MMD, 17 disease controls without
MMD, and 12 healthy donors were included. Proteomic profiles of dural tissues from 4 MMD and
4 disease controls were analyzed by an isobaric tag for relative and absolute quantitation (iTRAQ)-
based proteomics. The immune-related proteins were explored by bioinformatics and the key MMDrelated
proteins were verified by western blot, multiple reaction monitoring methods, enzyme-linked
immunosorbent assay, and tissue microarray.
Results:
1,120 proteins were identified, and 82 MMD-related proteins were found with more than 1.5
fold difference compared with those in the control samples. Gene Ontology analysis showed that 29
proteins were immune-related. In particular, Haptoglobin (HP) was up-regulated in dural tissue and
plasma of MMD samples compared to the controls, and its up-regulation was found to be sex- and
MMD Suzuki grade dependent. Through Receiver Operating Characteristic (ROC) analysis, HP can
well discriminate MMD and healthy donors with the Area Under the Curve (AUC) of 0.953.
Conclusion:
We identified the biggest protein database of the dura mater. 29 out of 82 differentially
expressed proteins in MMD are involved in the immune process. Of which, HP was up-regulated in
dural tissue and plasma of MMD, with sex- and MMD Suzuki grade-dependence. HP might be a potential
biomarker of MMD.
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Affiliation(s)
- Xiaojun Zhang
- The 85th Hospital of the Chinese People's Liberation Army, Shanghai 200052, China
| | - Lin Yin
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xiaofang Jia
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Yujiao Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Tiefu Liu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Lijun Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
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Oh WO, Shim KW, Yeom I, Park IT, Heo Y. Features and diversity of symptoms of moyamoya disease in adolescents: A cluster analysis. J Adv Nurs 2021; 77:2319-2327. [PMID: 33426712 DOI: 10.1111/jan.14723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
AIMS The purpose of this study is to explore the symptoms experienced by adolescents with moyamoya disease and to identify the characteristics of each symptom cluster associated with moyamoya disease. DESIGN A retrospective and descriptive design, which is a secondary data analysis study based on electronic medical record data from hospitals. METHODS To assess the symptoms associated with moyamoya disease, a qualitative study was conducted on 12 adolescents, 12 caregivers and 12 experts on moyamoya disease. According to a qualitative study, 12 main symptoms (limb weakness, numbness, pins and needles, difficulty in speech, blurred vision, facial paralysis, hand tremors, involuntary movements, convulsions, dizziness, nausea/vomiting and headaches) were selected. Data were collected around these symptoms. The data collection was carried out through the Electronic Medical Record (EMR) data of 303 adolescents aged 13-19 who were diagnosed with moyamoya disease (ICD 10 Code: I67.5) between January 2010-December 2019 in a hospital in Seoul, South Korea. Cluster analysis was applied to identify symptom clusters with the hierarchical cluster agglomerative approach. We used the log-likelihood distance to measure the similarity of variables. Proximity between groups of variables was measured using the two-step method. RESULTS The physical symptoms experienced by adolescents with moyamoya disease were 'limb weakness' - the most common - followed by a 'headache,' 'difficulty in speech,' and 'nausea/vomiting.' A total of five symptom clusters were derived: cluster 1 was characterized by 'limb weakness'; cluster 2 participants were asymptomatic or experienced 'convulsions'; cluster 3 experienced 'difficulty in speech' and 'facial paralysis'; cluster 4 is prone to 'dizziness' and 'pins and needles'; and cluster 5 displays 'headaches' and 'nausea/vomiting'. CONCLUSION This study offers a multidimensional approach for identifying differences in clinical symptoms of moyamoya disease among adolescents. IMPACT These results will help provide interventions concerning the characteristics of the symptoms of moyamoya disease among adolescents.
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Affiliation(s)
- Won-Oak Oh
- College of Nursing, Korea University, Seoul, South Korea
| | - Kyu Won Shim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University Health System, Seoul, Korea
| | - Insun Yeom
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University Health System, Seoul, Korea
| | - Il Tae Park
- College of Nursing, Korea University, Seoul, South Korea
| | - YooJin Heo
- College of Nursing, Korea University, Seoul, South Korea
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Han W, Qiao Y, Zhang H, Geng C, Zhu X, Liao D, Guo Y, Yang M, Chen D, Jiang P. Circulating sortilin levels are associated with inflammation in patients with moyamoya disease. Metab Brain Dis 2021; 36:103-109. [PMID: 32940806 DOI: 10.1007/s11011-020-00616-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 09/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Systemic inflammation has been implicated in the pathogenesis of moyamoya disease (MMD). Sortilin is a critical regulator of proinflammatory cytokine secretion in several cell types. The present study investigated the association between circulating sortilin and proinflammatory cytokine levels and the occurrence of MMD. METHODS Forty-two MMD cases and 76 age- and sex-matched controls were enrolled in this study between January 2018 and June 2019 at the Affiliated Hospital of Jining Medical University. The demographic and clinical characteristics were evaluated, and the circulating serum and cerebrospinal fluid (CSF) levels of sortilin, sortilin-related receptor with A-type repeats (SorLA), and proinflammatory cytokines including C-reactive protein (CRP), interleukin (IL)-6, interferon (IFN)-γ were measured by enzyme-linked immunosorbent assay. Linear regression and correlation analyses were used to estimate the associations between sortilin, SorLA, and proinflammatory cytokine levels. RESULTS MMD patients had higher serum levels of sortilin (P = 0.012), CRP (P = 0.013), IL-6 (P = 0.004), and IFN-γ (P = 0.033) than healthy controls. In MMD patients, serum sortilin was positively correlated with serum proinflammatory cytokines (CRP: r = 0.459, P = 0.0022; IL-6: r = 0.445, P = 0.0032; and IFN-γ: r = 0.448, P = 0.0029) and CSF sortilin (r = 0.440, P = 0.0035); the latter was positively correlated with CSF levels of CRP (r = 0.542, P = 0.0002), IL-6 (r = 0.440, P = 0.0036), and IFN-γ (r = 0.443, P = 0.0033). CONCLUSIONS Elevated sortilin level is associated MMD onset and may be a clinically useful biomarker along with proinflammatory cytokine levels.
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Affiliation(s)
- Wenxiu Han
- Institute of Clinical Pharmacy & Pharmacology, Jining First People's Hospital, Jining Medical University, 6, Jiankang Road, Jining, 272011, China
| | - Yi Qiao
- Department of Public Health, Jining Medical University, 272000, Jining, China
| | - Hailiang Zhang
- Institute of Clinical Pharmacy & Pharmacology, Jining First People's Hospital, Jining Medical University, 6, Jiankang Road, Jining, 272011, China
| | - Chunmei Geng
- Institute of Clinical Pharmacy & Pharmacology, Jining First People's Hospital, Jining Medical University, 6, Jiankang Road, Jining, 272011, China
| | - Xing Zhu
- Department of Medical Engineering, Jining Medical University, 272000, Jining, China
| | - Dehua Liao
- Department of Pharmacy, Hunan Cancer Hospital, Central South University, Changsha, 410011, China
| | - Yujin Guo
- Institute of Clinical Pharmacy & Pharmacology, Jining First People's Hospital, Jining Medical University, 6, Jiankang Road, Jining, 272011, China
| | - Mengqi Yang
- Institute of Clinical Pharmacy & Pharmacology, Jining First People's Hospital, Jining Medical University, 6, Jiankang Road, Jining, 272011, China
| | - Dan Chen
- Institute of Clinical Pharmacy & Pharmacology, Jining First People's Hospital, Jining Medical University, 6, Jiankang Road, Jining, 272011, China
| | - Pei Jiang
- Institute of Clinical Pharmacy & Pharmacology, Jining First People's Hospital, Jining Medical University, 6, Jiankang Road, Jining, 272011, China.
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Comparison of Operative and Conservative Treatment for Asymptomatic Moyamoya Disease: Preliminary Experience in Small Retrospective Series. World Neurosurg 2020; 146:e955-e960. [PMID: 33217589 DOI: 10.1016/j.wneu.2020.11.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The best management of asymptomatic moyamoya disease (MMD) remains controversial. In this study, the authors aimed to explore an experience for treatment modality for asymptomatic MMD. METHODS The authors retrospectively reviewed a total of 23 patients (age range 30-58 years) with asymptomatic MMD during the past 5 years at their institutions. The patients were divided into 2 groups: The surgical group included 11 patients, and the conservative group included 12 patients. The demographic, radiologic, and clinical findings of the patients were evaluated. At follow-up over 13-65 months, the future clinical and radiologic progression events were evaluated. RESULTS During the follow-up period, 3 patients suffered from future clinical progression events in the conservative group: 1 experienced stroke, and 2 experienced transient ischemic attack. Among the patients in the surgical group, only 1 experienced transient ischemic attack. Kaplan-Meier analysis showed that patients undergoing surgeries had longer clinical progression-free survival times compared with patients in the conservative group (P = 0.002). CONCLUSIONS Surgical treatment may be an alternative choice for patients with asymptomatic MMD. However, the best strategy for asymptomatic MMD in order to reduce future cerebrovascular risks still needs to be further explored.
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Gao XY, Li Q, Li JR, Zhou Q, Qu JX, Yao ZW. A perfusion territory shift attributable solely to the secondary collaterals in moyamoya patients: a potential risk factor for preoperative hemorrhagic stroke revealed by t-ASL and 3D-TOF-MRA. J Neurosurg 2020; 133:780-788. [PMID: 31398708 DOI: 10.3171/2019.5.jns19803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors conducted a study to noninvasively and nonradioactively reveal moyamoya disease (MMD) intracerebral perfusion and perfusion territory supplied by the unilateral internal carotid artery (ICA) and external carotid artery (ECA) and bilateral vertebral arteries (VAs) before surgery and to further identify risk factors for preoperative hemorrhage in adult MMD. METHODS Forty-three consecutive adult patients with bilateral MMD underwent unenhanced T1-weighted MRI, territorial arterial spin labeling (t-ASL), and unenhanced 3D time-of-flight MRA (3D-TOF-MRA). Clinical factors, including age, sex, hypertension, diabetes mellitus, hyperlipidemia, current smoking status, and history of taking aspirin, were gathered and stratified. Univariate logistic regression analyses were used to examine the relationship between various risk factors and the occurrence of preoperative hemorrhage. Stepwise multivariate logistic regression analyses were used to determine independent risk factors of preoperative hemorrhage in MMD. RESULTS Among the 86 MMD hemispheres, t-ASL revealed 137 perfusion territory shifts in 79 hemispheres. Five distinct categories of perfusion territory shifts were observed on t-ASL maps. The subtypes of perfusion territory shift on t-ASL maps were further subdivided into 2 different categories, group A and group B, in combination with findings on 3D-TOF-MRA. A perfusion territory shift attributable solely to the secondary collaterals was a potential independent risk factor for preoperative hemorrhage (p = 0.026; 95% CI 1.201-18.615; OR 4.729). After eliminating the influence of the secondary collaterals, the primary collaterals had no significant effect on the risk of preoperative hemorrhage (p = 0.182). CONCLUSIONS t-ASL could reveal comprehensive MMD cerebral blood perfusion and the vivid perfusion territory shifts fed by the unilateral ICA and ECA and bilateral VAs in a noninvasive, straightforward, nonradioactive, and nonenhanced manner. 3D-TOF-MRA could subdivide t-ASL perfusion territory shifts according to their shunt arteries. A perfusion territory shift attributable to the secondary collaterals is a potential independent risk factor for preoperative hemorrhage in MMD patients. A perfusion territory shift fed by the primary collaterals may not have a strong effect on preoperative hemorrhage in MMD patients. These findings make the combined modalities of t-ASL and 3D-TOF-MRA a feasible tool for MMD disease assessment, management, and surgical strategy planning.
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Affiliation(s)
- Xin-Yi Gao
- 1Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province
| | - Qiao Li
- 2Department of Radiology, Shanghai Cancer Center, Fudan University
| | - Jing-Run Li
- 3Department of Neurosurgery, Huashan Hospital, Fudan University
| | - Qian Zhou
- 4Shanghai International Travel Medical Center
| | - Jian-Xun Qu
- 5Department of GE Healthcare China, MR Research China; and
| | - Zhen-Wei Yao
- 6Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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Birkeland P, Tharmabalan V, Lauritsen J, Ganesan V, Bjarkam CR, Weitzel‐Mudersbach P. Moyamoya disease in a European setting: a Danish population‐based study. Eur J Neurol 2020; 27:2446-2452. [DOI: 10.1111/ene.14439] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Affiliation(s)
- P. Birkeland
- Department of Neurosurgery Aalborg University Hospital Aalborg Denmark
| | - V. Tharmabalan
- Department of Neurosurgery Aalborg University Hospital Aalborg Denmark
| | - J. Lauritsen
- Department of Orthopaedic Surgery Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - V. Ganesan
- Department of Paediatric Neurology Great Ormond Street Hospital London UK
| | - C. R. Bjarkam
- Department of Neurosurgery Aalborg University Hospital Aalborg Denmark
| | - P. Weitzel‐Mudersbach
- Department of Neurology Danish Stroke Center Aarhus University Hospital Aarhus Denmark
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Postpartum-Onset Moyamoya Disease: A Rare Cause of Stroke in Unexpected. Case Rep Neurol Med 2020; 2020:7689450. [PMID: 32733722 PMCID: PMC7378609 DOI: 10.1155/2020/7689450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/01/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic cerebrovascular occlusive disease that is characterized by progressive bilateral stenosis of the terminal portion of the internal carotid artery and its main branches. Cerebrovascular events are the primary presenting symptoms and are related both to stenosis and occlusion of the ICAs and their main branches. Detection of bilateral stenosis by cerebral angiography is considered the gold standard, but computed tomography angiography (CTA) is also an acceptable method of diagnosis. In the current literature, there are no precise data on the incidence of moyamoya disease in Europe and the United States. Also, the pathogenesis of MMD remains obscure, and genetic factors and inflammation are the two most representative mechanisms. Here, we report the case of MMD in a 29-year-old African American female who presented with an ischemic stroke for the second time that manifested after pregnancy. This case is important to increase awareness of the probability of this rare disease in Western countries as well as to call attention to pregnancy's accelerating effects of MMD. Careful, long-term neurologic and radiologic follow-up is essential in adult patients with MMD to prevent additional stroke events and improve outcomes.
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