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Abumiya T, Fujimura M. Moyamoya Vasculopathy and Moyamoya-Related Systemic Vasculopathy: A Review With Histopathological and Genetic Viewpoints. Stroke 2024; 55:1699-1706. [PMID: 38690664 DOI: 10.1161/strokeaha.124.046999] [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: 05/02/2024]
Abstract
Systemic vasculopathy has occasionally been reported in cases of moyamoya disease (MMD). Since the pathological relationship between moyamoya vasculopathy (MMV) and moyamoya-related systemic vasculopathy (MMRSV) remains unclear, it was examined herein by a review of histopathologic studies in consideration of clinicopathological and genetic viewpoints. Although luminal stenosis was a common finding in MMV and MMRSV, histopathologic findings of vascular remodeling markedly differed. MMV showed intimal hyperplasia, marked medial atrophy, and redundant tortuosity of the internal elastic lamina, with outer diameter narrowing called negative remodeling. MMRSV showed hyperplasia, mainly in the intima and sometimes in the media, with disrupted stratification of the internal elastic lamina. Systemic vasculopathy has also been observed in patients with non-MMD carrying the RNF213 (ring finger protein 213) mutation, leading to the concept of RNF213 vasculopathy. RNF213 vasculopathy in patients with non-MMD was histopathologically similar to MMRSV. Cases of MMRSV have sometimes been diagnosed with fibromuscular dysplasia. Fibromuscular dysplasia is similar to MMD not only in the histopathologic findings of MMRSV but also from clinicopathological and genetic viewpoints. The significant histopathologic difference between MMV and MMRSV may be attributed to a difference in the original vascular wall structure and its resistance to pathological stress between the intracranial and systemic arteries. To understand the pathogeneses of MMD and MMRSV, a broader perspective that includes RNF213 vasculopathy and fibromuscular dysplasia as well as an examination of the 2- or multiple-hit theory consisting of genetic factors, vascular structural conditions, and vascular environmental factors, such as blood immune cells and hemodynamics, are needed.
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Affiliation(s)
- Takeo Abumiya
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.A., M.F.)
- Department of Neurosurgery, Miyanomori Memorial Hospital, Sapporo, Japan (T.A.)
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.A., M.F.)
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2
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Marra CM. Infectious and Postinfectious Vasculopathies. Neuroimaging Clin N Am 2024; 34:13-21. [PMID: 37951699 DOI: 10.1016/j.nic.2023.06.001] [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: 11/14/2023]
Abstract
Stroke is a complication of many central nervous system (CNS) infections, but only a few present with stroke without other symptoms or signs of CNS infection. Chief among these are varicella zoster virus (VZV) and syphilis. Delayed cerebral vasculopathy after successful treatment of bacterial meningitis, most commonly pneumococcal, is an emerging entity with uncertain pathogenesis.
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Affiliation(s)
- Christina M Marra
- Department of Neurology, University of Washington, Seattle, WA, USA.
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3
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Kim HK, Jang Y, Seo T, Shin JW. Chronic recurrent delayed cerebral vasculopathy after pneumococcal meningitis. Acta Neurol Belg 2023; 123:2039-2041. [PMID: 36331726 DOI: 10.1007/s13760-022-02128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Hyun Kyung Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam-Si, Korea
| | - Yeji Jang
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam-Si, Korea
| | - Taeho Seo
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam-Si, Korea
| | - Jung-Won Shin
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam-Si, Korea.
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Arficho KT, Gumma C, Chakko MN. Post Cryptococcal Moyamoya Syndrome in Adult Human Immunodeficiency Virus Patient With Anterior and Posterior Circulation Involvement: Case Report. Cureus 2023; 15:e44052. [PMID: 37746378 PMCID: PMC10517719 DOI: 10.7759/cureus.44052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Moyamoya disease (MMD) is a rare idiopathic progressive vaso-occlusive disease characterized by irreversible vascular occlusion and collateral development of distal internal carotid arteries. Initially perceived as an exclusive entity to the East Asian population, the disease is now being reported globally, affecting individuals of diverse ethnicities. We present a case of a 55-year-old African American male patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and a prior history of cryptococcal meningitis presenting to the emergency department with recurrent episodic headaches, which was refractory to routine medical therapy. Neuroimaging with computed tomography angiogram of the head and neck and magnetic resonance imaging of the brain led to the subsequent diagnosis of moyamoya syndrome (MMS). To our knowledge, MMS is uncommon in adult HIV/AIDS patients. It is crucial that clinicians are aware of the disease progression. For effective recognition and prevention of the condition, it is of utmost importance that clinicians possess a comprehensive understanding of the disease and its clinical manifestations.
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Affiliation(s)
- Kidist T Arficho
- Radiology, Ascension Providence Hospital, Michigan State University College of Human Medicine (MSUCHM), Southfield, USA
| | - Cezar Gumma
- Radiology, Beaumont Hospital, Farmington Hills, USA
| | - Mathew N Chakko
- Neuroradiology, Ascension Providence Hospital, Michigan State University College of Human Medicine (MSUCHM), Southfield, USA
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Dorschel KB, Wanebo JE. Physiological and pathophysiological mechanisms of the molecular and cellular biology of angiogenesis and inflammation in moyamoya angiopathy and related vascular diseases. Front Neurol 2023; 14:661611. [PMID: 37273690 PMCID: PMC10236939 DOI: 10.3389/fneur.2023.661611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 01/16/2023] [Indexed: 06/06/2023] Open
Abstract
Rationale The etiology and pathophysiological mechanisms of moyamoya angiopathy (MMA) remain largely unknown. MMA is a progressive, occlusive cerebrovascular disorder characterized by recurrent ischemic and hemorrhagic strokes; with compensatory formation of an abnormal network of perforating blood vessels that creates a collateral circulation; and by aberrant angiogenesis at the base of the brain. Imbalance of angiogenic and vasculogenic mechanisms has been proposed as a potential cause of MMA. Moyamoya vessels suggest that aberrant angiogenic, arteriogenic, and vasculogenic processes may be involved in the pathophysiology of MMA. Circulating endothelial progenitor cells have been hypothesized to contribute to vascular remodeling in MMA. MMA is associated with increased expression of angiogenic factors and proinflammatory molecules. Systemic inflammation may be related to MMA pathogenesis. Objective This literature review describes the molecular mechanisms associated with cerebrovascular dysfunction, aberrant angiogenesis, and inflammation in MMA and related cerebrovascular diseases along with treatment strategies and future research perspectives. Methods and results References were identified through a systematic computerized search of the medical literature from January 1, 1983, through July 29, 2022, using the PubMed, EMBASE, BIOSIS Previews, CNKI, ISI web of science, and Medline databases and various combinations of the keywords "moyamoya," "angiogenesis," "anastomotic network," "molecular mechanism," "physiology," "pathophysiology," "pathogenesis," "biomarker," "genetics," "signaling pathway," "blood-brain barrier," "endothelial progenitor cells," "endothelial function," "inflammation," "intracranial hemorrhage," and "stroke." Relevant articles and supplemental basic science articles almost exclusively published in English were included. Review of the reference lists of relevant publications for additional sources resulted in 350 publications which met the study inclusion criteria. Detection of growth factors, chemokines, and cytokines in MMA patients suggests the hypothesis of aberrant angiogenesis being involved in MMA pathogenesis. It remains to be ascertained whether these findings are consequences of MMA or are etiological factors of MMA. Conclusions MMA is a heterogeneous disorder, comprising various genotypes and phenotypes, with a complex pathophysiology. Additional research may advance our understanding of the pathophysiology involved in aberrant angiogenesis, arterial stenosis, and the formation of moyamoya collaterals and anastomotic networks. Future research will benefit from researching molecular pathophysiologic mechanisms and the correlation of clinical and basic research results.
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Affiliation(s)
- Kirsten B. Dorschel
- Medical Faculty, Heidelberg University Medical School, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - John E. Wanebo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
- Department of Neuroscience, HonorHealth Research Institute, Scottsdale, AZ, United States
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Kappel AD, Lehman LL, Northam WT, See AP, Smith ER. Pediatric Moyamoya Syndrome Secondary to Tuberculous Meningitis: A Case Report. Neurol Clin Pract 2023; 13:e200121. [PMID: 36865644 PMCID: PMC9973290 DOI: 10.1212/cpj.0000000000200121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/02/2022] [Indexed: 01/20/2023]
Abstract
Objectives Tuberculosis is uncommon in the United States and a rare cause of meningitis in children with severe neurologic consequences. Tuberculous meningitis (TBM) is an even rarer cause of moyamoya syndrome with only a handful of cases previously reported. Methods We report the case of a female patient who initially presented at 6 years of age with TBM and developed moyamoya syndrome requiring revascularization surgery. Results She was found to have basilar meningeal enhancement and right basal ganglia infarcts. She was treated with 12 months of antituberculosis therapy and 12 months of enoxaparin and maintained on daily aspirin indefinitely. However, she developed recurrent headaches and transient ischemic attacks and was found to have progressive bilateral moyamoya arteriopathy. At age 11 years, she underwent bilateral pial synangiosis for the treatment of her moyamoya syndrome. Discussion Moyamoya syndrome is a rare but serious sequalae of TBM and may be more common in pediatric patients. The risk of stroke may be mitigated by pial synangiosis or other revascularization surgeries in carefully selected patients.
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Affiliation(s)
- Ari D Kappel
- Department of Neurosurgery (ADK, WTN, APS, ERS), Boston Children's Hospital, Harvard Medical School, Boston; Department of Neurosurgery (ADK), Brigham and Women's Hospital, Harvard Medical School, Boston; and Department of Neurology (LLL), Boston Children's Hospital, Harvard Medical School, MA
| | - Laura L Lehman
- Department of Neurosurgery (ADK, WTN, APS, ERS), Boston Children's Hospital, Harvard Medical School, Boston; Department of Neurosurgery (ADK), Brigham and Women's Hospital, Harvard Medical School, Boston; and Department of Neurology (LLL), Boston Children's Hospital, Harvard Medical School, MA
| | - Weston T Northam
- Department of Neurosurgery (ADK, WTN, APS, ERS), Boston Children's Hospital, Harvard Medical School, Boston; Department of Neurosurgery (ADK), Brigham and Women's Hospital, Harvard Medical School, Boston; and Department of Neurology (LLL), Boston Children's Hospital, Harvard Medical School, MA
| | - Alfred P See
- Department of Neurosurgery (ADK, WTN, APS, ERS), Boston Children's Hospital, Harvard Medical School, Boston; Department of Neurosurgery (ADK), Brigham and Women's Hospital, Harvard Medical School, Boston; and Department of Neurology (LLL), Boston Children's Hospital, Harvard Medical School, MA
| | - Edward R Smith
- Department of Neurosurgery (ADK, WTN, APS, ERS), Boston Children's Hospital, Harvard Medical School, Boston; Department of Neurosurgery (ADK), Brigham and Women's Hospital, Harvard Medical School, Boston; and Department of Neurology (LLL), Boston Children's Hospital, Harvard Medical School, MA
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Liu E, Liu C, Jin L, Zhou H, Tan X, Zhang G, Tao W, Gao X, Zhao H, Luo C, Li X, Yang S. Clinical value of the systemic immune-inflammation index in moyamoya disease. Front Neurol 2023; 14:1123951. [PMID: 37153657 PMCID: PMC10157187 DOI: 10.3389/fneur.2023.1123951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/21/2023] [Indexed: 05/10/2023] Open
Abstract
Background Moyamoya disease (MMD) is a rare cerebrovascular disorder with unknown etiology. The underlying pathophysiological mechanism of moyamoya disease remains to be elucidated, but recent studies have increasingly highlighted that abnormal immune response may be a potential trigger for MMD. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are inflammatory markers that can reflect the immune-inflammation state of the disease. Objective The purpose of this study was to investigate SII, NLR, and PLR in patients with moyamoya disease. Methods A total of 154 patients with moyamoya disease (MMD group) and 321 age- and sex-matched healthy subjects (control group) were included in this retrospective case-control study. Complete blood count parameters were assayed to calculate the SII, NLR, and PLR values. Results The SII, NLR, and PLR values in the moyamoya disease group were significantly higher than those in the control group [754 ± 499 vs. 411 ± 205 (P < 0.001), 2.83 ± 1.98 vs. 1.81 ± 0.72 (P < 0.001), and 152 ± 64 vs. 120 ± 42 (P < 0.001), respectively]. The SII in the medium-moyamoya vessels of moyamoya disease was higher than that in the high-moyamoya vessels and low-moyamoya vessels (P = 0.005). Using the receiver operating characteristic (ROC) curve analysis to predict MMD, the highest area under the curve (AUC) was determined for SII (0.76 for SII, 0.69 for NLR, and 0.66 for PLR). Conclusion Based on the results of this study, patients with moyamoya disease admitted for inpatient care due to acute or chronic stroke have significantly higher SII, NLR, and PLR when compared to blood samples drawn from completely healthy controls in a non-emergent outpatient setting. While the findings may suggest that inflammation plays a role in moyamoya disease, further studies are warranted to corroborate such an association. In the middle stage of moyamoya disease, there may be a more intense imbalance of immune inflammation. Further studies are needed to determine whether the SII index contributes to the diagnosis or serves as a potential marker of an inflammatory response in patients with moyamoya disease.
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Affiliation(s)
- Erheng Liu
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Chengyuan Liu
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Lide Jin
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Hu Zhou
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Xueyi Tan
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Guibo Zhang
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Weihua Tao
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Xiang Gao
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Heng Zhao
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Chao Luo
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Xuehua Li
- Department of AIDS/STDs Prevention and Control, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
- *Correspondence: Xuehua Li
| | - Shuaifeng Yang
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
- Shuaifeng Yang
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Li S, Han Y, Zhang Q, Tang D, Li J, Weng L. Comprehensive molecular analyses of an autoimmune-related gene predictive model and immune infiltrations using machine learning methods in moyamoya disease. Front Mol Biosci 2022; 9:991425. [PMID: 36605987 PMCID: PMC9808060 DOI: 10.3389/fmolb.2022.991425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Growing evidence suggests the links between moyamoya disease (MMD) and autoimmune diseases. However, the molecular mechanism from genetic perspective remains unclear. This study aims to clarify the potential roles of autoimmune-related genes (ARGs) in the pathogenesis of MMD. Methods: Two transcription profiles (GSE157628 and GSE141025) of MMD were downloaded from GEO databases. ARGs were obtained from the Gene and Autoimmune Disease Association Database (GAAD) and DisGeNET databases. Differentially expressed ARGs (DEARGs) were identified using "limma" R packages. GO, KEGG, GSVA, and GSEA analyses were conducted to elucidate the underlying molecular function. There machine learning methods (LASSO logistic regression, random forest (RF), support vector machine-recursive feature elimination (SVM-RFE)) were used to screen out important genes. An artificial neural network was applied to construct an autoimmune-related signature predictive model of MMD. The immune characteristics, including immune cell infiltration, immune responses, and HLA gene expression in MMD, were explored using ssGSEA. The miRNA-gene regulatory network and the potential therapeutic drugs for hub genes were predicted. Results: A total of 260 DEARGs were identified in GSE157628 dataset. These genes were involved in immune-related pathways, infectious diseases, and autoimmune diseases. We identified six diagnostic genes by overlapping the three machine learning algorithms: CD38, PTPN11, NOTCH1, TLR7, KAT2B, and ISG15. A predictive neural network model was constructed based on the six genes and presented with great diagnostic ability with area under the curve (AUC) = 1 in the GSE157628 dataset and further validated by GSE141025 dataset. Immune infiltration analysis showed that the abundance of eosinophils, natural killer T (NKT) cells, Th2 cells were significant different between MMD and controls. The expression levels of HLA-A, HLA-B, HLA-C, HLA-DMA, HLA-DRB6, HLA-F, and HLA-G were significantly upregulated in MMD. Four miRNAs (mir-26a-5p, mir-1343-3p, mir-129-2-3p, and mir-124-3p) were identified because of their interaction at least with four hub DEARGs. Conclusion: Machine learning was used to develop a reliable predictive model for the diagnosis of MMD based on ARGs. The uncovered immune infiltration and gene-miRNA and gene-drugs regulatory network may provide new insight into the pathogenesis and treatment of MMD.
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Affiliation(s)
- Shifu Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Ying Han
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Qian Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Dong Tang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Jian Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China,Hydrocephalus Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Weng
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China,Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China,*Correspondence: Ling Weng,
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Moyamoya disease emerging as an immune-related angiopathy. Trends Mol Med 2022; 28:939-950. [DOI: 10.1016/j.molmed.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022]
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Nakamura Y, Mineharu Y, Kamata T, Funaki T, Miyamoto S, Koizumi A, Harada KH. Lack of Association between Seropositivity of Vasculopathy-Related Viruses and Moyamoya Disease. J Stroke Cerebrovasc Dis 2022; 31:106509. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022] Open
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Kato M, Kudo Y, Hatase M, Tsuchida N, Takeyama S, Sugiyama T, Fujimura M, Yabe I, Tsujimoto H, Fukumori Y, Inoue N, Atsumi T. Moyamoya Disease Associated with a Deficiency of Complement Component 6. J Stroke Cerebrovasc Dis 2022; 31:106601. [PMID: 35717718 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106601] [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: 02/07/2022] [Revised: 05/21/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Complement component 6 (C6) deficiency is a very rare genetic defect that leads to significantly diminished synthesis, secretion, or function of C6. In the current report, we demonstrate a previously undescribed, homozygous missense mutation in exon 17 of the C6 gene (c.2545A>G p.Arg849Gly) in a 35-year-old Japanese woman with moyamoya disease and extremely low levels of CH50 (<7.0 U/mL). MATERIALS AND METHODS The complement gene analysis using hybridization capture-based next generation sequencing was performed. CH50 was determined in patient's plasma mixed with plasma from a healthy donor or purified human C6 protein. Western blot was performed on patient's plasma using polyclonal antibodies against C6, with healthy donor's plasma and purified human C6 protein as positive controls while C6-depleted human serum as a negative control. The carriage of ring finger protein 213 variant (c.14576G>A p.Arg4859Lys), a susceptibility gene for moyamoya disease, was examined by direct sequencing. RESULTS CH50 mixing test clearly showed a deficiency pattern, being rescued by addition of only 1% healthy donor's plasma or 1 μg/mL purified human C6 protein (1/50-1/100 of physiological concentration). Western blot revealed the absence of C6 protein in the patient's plasma, confirming a quantitative deficiency of C6. The ring finger protein 213 variant was not detected. CONCLUSIONS Our data implies that unrecognized complement deficiencies would be harbored in cerebrovascular diseases with unknown etiologies.
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Affiliation(s)
- Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N14W5, Kita-Ku, Sapporo 060-8648, Japan.
| | - Yuki Kudo
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N14W5, Kita-Ku, Sapporo 060-8648, Japan
| | - Masanao Hatase
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo 060-8648, Japan
| | - Naohisa Tsuchida
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N14W5, Kita-Ku, Sapporo 060-8648, Japan
| | - Shuhei Takeyama
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N14W5, Kita-Ku, Sapporo 060-8648, Japan
| | - Taku Sugiyama
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15W7, Kita-Ku, Sapporo 060-8648, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15W7, Kita-Ku, Sapporo 060-8648, Japan
| | - Ichiro Yabe
- The Division of Clinical Genetics, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo 060-8638, Japan
| | - Hiroshi Tsujimoto
- Department of Molecular Genetics, Wakayama Medical University, Kimiidera 811-1, Wakayama 641-8509, Japan
| | - Yasuo Fukumori
- Department of Molecular Genetics, Wakayama Medical University, Kimiidera 811-1, Wakayama 641-8509, Japan
| | - Norimitsu Inoue
- Department of Molecular Genetics, Wakayama Medical University, Kimiidera 811-1, Wakayama 641-8509, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N14W5, Kita-Ku, Sapporo 060-8648, Japan
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12
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Stone JR. Diseases of small and medium-sized blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Fox BM, Dorschel KB, Lawton MT, Wanebo JE. Pathophysiology of Vascular Stenosis and Remodeling in Moyamoya Disease. Front Neurol 2021; 12:661578. [PMID: 34539540 PMCID: PMC8446194 DOI: 10.3389/fneur.2021.661578] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/09/2021] [Indexed: 12/04/2022] Open
Abstract
Moyamoya disease (MMD) and moyamoya syndrome (MMS) are progressive vascular pathologies unique to the cerebrovasculature that are important causes of stroke in both children and adults. The natural history of MMD is characterized by primary progressive stenosis of the supraclinoid internal carotid artery, followed by the formation of fragile collateral vascular networks. In MMS, stenosis and collateralization occur in patients with an associated disease or condition. The pathological features of the stenosis associated with MMD include neointimal hyperplasia, disruption of the internal elastic lamina, and medial attenuation, which ultimately lead to progressive decreases in both luminal and external arterial diameter. Several molecular pathways have been implicated in the pathophysiology of stenosis in MMD with functions in cellular proliferation and migration, extracellular matrix remodeling, apoptosis, and vascular inflammation. Importantly, several of these molecular pathways overlap with those known to contribute to diseases of systemic arterial stenosis, such as atherosclerosis and fibromuscular dysplasia (FMD). Despite these possible shared mechanisms of stenosis, the contrast of MMD with other stenotic pathologies highlights the central questions underlying its pathogenesis. These questions include why the stenosis that is associated with MMD occurs in such a specific and limited anatomic location and what process initiates this stenosis. Further investigation of these questions is critical to developing an understanding of MMD that may lead to disease-modifying medical therapies. This review may be of interest to scientists, neurosurgeons, and neurologists involved in both moyamoya research and treatment and provides a review of pathophysiologic processes relevant to diseases of arterial stenosis on a broader scale.
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Affiliation(s)
- Brandon M Fox
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Kirsten B Dorschel
- Medical Faculty, Heidelberg University Medical School, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Michael T Lawton
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - John E Wanebo
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
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Ishisaka E, Watanabe A, Murai Y, Shirokane K, Matano F, Tsukiyama A, Baba E, Nakagawa S, Tamaki T, Mizunari T, Tanikawa R, Morita A. Role of RNF213 polymorphism in defining quasi-moyamoya disease and definitive moyamoya disease. Neurosurg Focus 2021; 51:E2. [PMID: 34469872 DOI: 10.3171/2021.5.focus21182] [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: 03/24/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Quasi-moyamoya disease (QMMD) is moyamoya disease (MMD) associated with additional underlying diseases. Although the ring finger protein 213 (RNF213) c.14576G>A mutation is highly correlated with MMD in the Asian population, its relationship to QMMD is unclear. Therefore, in this study the authors sought to investigate the RNF213 c.14576G>A mutation in the genetic diagnosis and classification of QMMD. METHODS This case-control study was conducted among four core hospitals. A screening system for the RNF213 c.14576G>A mutation based on high-resolution melting curve analysis was designed. The prevalence of RNF213 c.14576G>A was investigated in 76 patients with MMD and 10 patients with QMMD. RESULTS There were no significant differences in age, sex, family history, and mode of onset between the two groups. Underlying diseases presenting in patients with QMMD were hyperthyroidism (n = 6), neurofibromatosis type 1 (n = 2), Sjögren's syndrome (n = 1), and meningitis (n =1). The RNF213 c.14576G>A mutation was found in 64 patients (84.2%) with MMD and 8 patients (80%) with QMMD; no significant difference in mutation frequency was observed between cohorts. CONCLUSIONS There are two forms of QMMD, one in which the vascular abnormality is associated with an underlying disease, and the other in which MMD is coincidentally complicated by an unrelated underlying disease. It has been suggested that the presence or absence of the RNF213 c.14576G>A mutation may be useful in distinguishing between these disease types.
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Affiliation(s)
- Eitaro Ishisaka
- 1Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo
| | - Atsushi Watanabe
- 2Division of Clinical Genetics, Kanazawa University Hospital, Kanazawa, Ishikawa.,3Support Center for Genetic Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa
| | - Yasuo Murai
- 1Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo
| | - Kazutaka Shirokane
- 4Department of Neurosurgery, Nippon Medical School, Tama-Nagayama Hospital, Tama, Tokyo
| | - Fumihiro Matano
- 1Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo
| | - Atsushi Tsukiyama
- 1Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo
| | - Eiichi Baba
- 1Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo
| | - Shunsuke Nakagawa
- 1Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo
| | - Tomonori Tamaki
- 4Department of Neurosurgery, Nippon Medical School, Tama-Nagayama Hospital, Tama, Tokyo
| | - Takayuki Mizunari
- 5Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Chiba; and
| | - Rokuya Tanikawa
- 6Department of Neurosurgery, Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Akio Morita
- 1Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo
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15
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Mineharu Y, Miyamoto S. RNF213 and GUCY1A3 in Moyamoya Disease: Key Regulators of Metabolism, Inflammation, and Vascular Stability. Front Neurol 2021; 12:687088. [PMID: 34381413 PMCID: PMC8350054 DOI: 10.3389/fneur.2021.687088] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
Moyamoya disease is an idiopathic chronically progressive cerebrovascular disease, which causes both ischemic and hemorrhagic stroke. Genetic studies identified RNF213/Mysterin and GUCY1A3 as disease-causing genes. They were also known to be associated with non-moyamoya intracranial large artery disease, coronary artery disease and pulmonary artery hypertension. This review focused on these two molecules and their strong linker, calcineurin/NFAT signaling and caveolin to understand the pathophysiology of moyamoya disease and related vascular diseases. They are important regulators of lipid metabolism especially lipotoxicity, NF-κB mediated inflammation, and nitric oxide-mediated vascular protection. Although intimal thickening with fibrosis and damaged vascular smooth muscle cells are the distinguishing features of moyamoya disease, origin of the fibrous tissue and the mechanism of smooth muscle cell damages remains not fully elucidated. Endothelial cells and smooth muscle cells have long been a focus of interest, but other vascular components such as immune cells and extracellular matrix also need to be investigated in future studies. Molecular research on moyamoya disease would give us a clue to understand the mechanism preserving vascular stability.
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Affiliation(s)
- Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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16
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Aruta G, Piatelli G, Pavanello M. Letter to the Editor Regarding "A Rare Case of Postinfectious Moyamoya Syndrome: Case Report and Review of the Literature". World Neurosurg 2021; 146:395-396. [PMID: 33607732 DOI: 10.1016/j.wneu.2020.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Affiliation(s)
- G Aruta
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy.
| | - G Piatelli
- Department of Neurosurgery, Istituto Giannina Gaslini, Genoa, Italy
| | - M Pavanello
- Department of Neurosurgery, Istituto Giannina Gaslini, Genoa, Italy
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17
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Abstract
Neuroinfectious diseases can affect immunocompetent and immunosuppressed individuals and cause a variety of emergencies including meningitis, encephalitis, and abscess. Neurologic infections are frequently complicated by secondary injuries that also present emergently such as cerebrovascular disease, acute obstructive hydrocephalus, and seizure. In most cases, timely recognition and early treatment of infection can improve the morbidity and mortality of infectious neurologic emergencies.
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18
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Significance of Serum Angiopoietin-2 in Patients with Hemorrhage in Adult-Onset Moyamoya Disease. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8209313. [PMID: 32802878 PMCID: PMC7424502 DOI: 10.1155/2020/8209313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/18/2020] [Accepted: 07/15/2020] [Indexed: 12/31/2022]
Abstract
Background Moyamoya disease (MMD) is a progressive occlusive cerebrovascular disease that is characterized by abnormal angiogenesis at the base of the brain. This pathological abnormal angiogenesis is susceptible to disturbances, including spontaneous hemorrhage and vasogenic edema. However, the underlying mechanisms of pathological angiogenesis and occurrence of hemorrhage are unclear. Angiopoietins play a fundamental role in the pathophysiology of central nervous system disorders in angiogenesis. This study was aimed at examining whether angiopoietins are associated with formation of abnormal collateral vessels and the occurrence of hemorrhage in adult-onset moyamoya disease (HMMD). Methods A total of 27 consecutive adult patients with HMMD were enrolled from June 2011 to May 2017. Serum levels of angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) were examined by enzyme-linked immunosorbent assay. Patients with HMMD were compared with those with spontaneous hemorrhage (controls) and nonhemorrhagic-onset MMD (NHMMD). Results Serum Ang-2 levels were significantly higher in patients with adult HMMD than in those with spontaneous hemorrhage and NHMMD. The ROC curve identified that a baseline serum Ang-2 level > 1230 ng/ml may be associated with adult HMMD with 88.39% sensitivity and 70.37% specificity (area under the curve (AUC), 0.89; 95% CI, 0.808-0.973; P < 0.001). Moreover, serum Ang-2 levels were significantly elevated in stages II, III, and IV. In subgroup analysis of a high and low degree of moyamoya vessels, serum Ang-2 levels were significantly higher in the high moyamoya vessel group than in the low moyamoya vessel group. Serum Ang-2 levels were also significantly higher in the low moyamoya vessel group compared with the control group. Serum Ang-1 levels were not significantly different among the groups. Conclusion Increased serum Ang-2 levels may contribute to pathological abnormal angiogenesis and/or to the instability of vascular structure and function, thus causing brain hemorrhage in adult HMMD.
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19
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A Rare Case of Postinfectious Moyamoya Syndrome: Case Report and Review of the Literature. World Neurosurg 2020; 140:213-218. [DOI: 10.1016/j.wneu.2020.05.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 11/18/2022]
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20
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Shi Z, Li Y, Liu P. In Reply to the Letter to the Editor Regarding "Intracranial Aneurysms Associated with Moyamoya Disease in Children: Clinical Features and Long-Term Surgical Outcome". World Neurosurg 2020; 139:636-637. [PMID: 32689653 DOI: 10.1016/j.wneu.2020.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Zhiyong Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Youxiang Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Peng Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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21
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Dargazanli C, De la Cruz E, Gaillard N, Costalat V, Arquizan C. Bilateral intracranial stenting for refractory post-infectious cerebral vasculitis secondary to Pneumococcal Meningitis. J Neuroradiol 2020; 48:132-136. [PMID: 32560919 DOI: 10.1016/j.neurad.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Cyril Dargazanli
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; Cerebrovascular Mechanisms of Brain Disorders, Institut de Génomique Fonctionnelle (IGF), UMR 5203 CNRS - U 1191 INSERM, Univ. Montpellier, 141, rue de la Cardonille, 34094 Montpellier Cedex 05, France; Institut de Génomique Fonctionnelle (IGF), UMR 5203 CNRS-U 1191 Inserm-University Montpellier, 141, rue de la cardonille, 34094 Montpellier cedex 05, France.
| | - Elisa De la Cruz
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.
| | - Nicolas Gaillard
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.
| | - Vincent Costalat
- Cerebrovascular Mechanisms of Brain Disorders, Institut de Génomique Fonctionnelle (IGF), UMR 5203 CNRS - U 1191 INSERM, Univ. Montpellier, 141, rue de la Cardonille, 34094 Montpellier Cedex 05, France; Institut de Génomique Fonctionnelle (IGF), UMR 5203 CNRS-U 1191 Inserm-University Montpellier, 141, rue de la cardonille, 34094 Montpellier cedex 05, France.
| | - Caroline Arquizan
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.
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22
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Maramattom B. Postcryptococcal Moyamoya Syndrome: Case Report and Review of Literature. Neurol India 2020; 68:660-664. [DOI: 10.4103/0028-3886.288983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Mikami T, Suzuki H, Komatsu K, Mikuni N. Influence of Inflammatory Disease on the Pathophysiology of Moyamoya Disease and Quasi-moyamoya Disease. Neurol Med Chir (Tokyo) 2019; 59:361-370. [PMID: 31281171 PMCID: PMC6796064 DOI: 10.2176/nmc.ra.2019-0059] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Moyamoya disease is a unique cerebrovascular disease that is characterized by progressive bilateral stenotic alteration at the terminal portion of the internal carotid arteries. These changes induce the formation of an abnormal vascular network composed of collateral pathways known as moyamoya vessels. In quasi-moyamoya disease, a similar stenotic vascular abnormality is associated with an underlying disease, which is sometimes an inflammatory disease. Recent advances in moyamoya disease research implicate genetic background and immunological mediators, and postulate an association with inflammatory disease as a cause of, or progressive factor in, quasi-moyamoya disease. Although this disease has well-defined clinical and radiological characteristics, the role of inflammation has not been rigorously explored. Herein, we focused on reviewing two main themes: (1) molecular biology of inflammation in moyamoya disease, and (2) clinical significance of inflammation in quasi-moyamoya disease. We have summarized the findings of the former theme according to the following topics: (1) inflammatory biomarkers, (2) genetic background of inflammatory response, (3) endothelial progenitor cells, and (4) noncoding ribonucleic acids. Under the latter theme, we summarized the findings according to the following topics: (1) influence of inflammatory disease, (2) vascular remodeling, and (3) mechanisms gleaned from clinical cases. This review includes articles published up to February 2019 and provides novel insights for the treatment of the moyamoya disease and quasi-moyamoya disease.
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Affiliation(s)
| | - Hime Suzuki
- Department of Neurosurgery, Sapporo Medical University
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24
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Late-onset cerebral vasculopathy complicating pneumococcal meningitis. A case report with unusual clinical features. Clin Neurol Neurosurg 2018; 174:26-28. [DOI: 10.1016/j.clineuro.2018.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 11/18/2022]
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25
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Sharawat IK, Subramani V, Kesavan S, Saini L. Rare vascular complication of acute meningococcal meningitis in a child. BMJ Case Rep 2018; 2018:bcr-2018-227069. [PMID: 30373900 DOI: 10.1136/bcr-2018-227069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Indar Kumar Sharawat
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Vignesh Subramani
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Shivan Kesavan
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Lokesh Saini
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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26
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Dou Z, Chen H, Cheng H, Liu G. Moyamoya syndrome after bacterial meningitis. Pediatr Investig 2018; 2:134-136. [PMID: 32851248 PMCID: PMC7331372 DOI: 10.1002/ped4.12048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/12/2018] [Indexed: 12/05/2022] Open
Affiliation(s)
- Zhenzhen Dou
- Department of Infectious DiseasesBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Heying Chen
- Department of Infectious DiseasesBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Hua Cheng
- Imaging CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Gang Liu
- Department of Infectious DiseasesBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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27
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Brandicourt P, Bonnet L, Béjot Y, Drouet C, Moulin T, Thines L. Moya-Moya syndrome after cranial radiation for optic glioma with NF1. Case report and literature review of syndromic cases. Neurochirurgie 2018; 64:63-67. [PMID: 29475609 DOI: 10.1016/j.neuchi.2017.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/18/2017] [Accepted: 11/27/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Moya-Moya angiopathy is a neurovascular disease that predisposes to ischemic or hemorrhagic strokes. It is generated by a steno-occlusion of the terminal portion of the internal carotid arteries, which induces the development of abnormal neovessels in the deep regions of the brain. Some pathologies such as sickle cell disease, Down syndrome or Graves' disease may be associated with Moya-Moya angiopathy. These syndromic forms harbor several differences compared with idiopathic Moya-Moya disease. CASE REPORT We report the case of a young patient who presented with a syndromic form of Moya-Moya angiopathy after cranial radiation therapy for an optic glioma associated with type 1 neurofibromatosis treated by combined revascularization. We discuss the particularities of syndromic forms, in their presentation and management based on a review of the literature. CONCLUSION Many diseases can be associated with Moya-Moya syndrome. Symptomatic patients should undergo surgery, but the risk of postoperative complications appears to be greater than that encountered in patients with non-syndromic Moya-Moya angiopathy.
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Affiliation(s)
- P Brandicourt
- Service de neurochirurgie, CHRU de Besançon, université Bourgogne-Franche-Comté, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
| | - L Bonnet
- Unité de neurologie vasculaire, CHRU de Besançon, université Bourgogne-Franche-Comté, 3, boulevard Alexandre-Fleming, 25030 Besançon, France
| | - Y Béjot
- Service de neurologie générale, vasculaire et dégénérative, CHU de Dijon, université Bourgogne-Franche-Comté, 14 rue Paul-Gaffarel, 21000 Dijon, France
| | - C Drouet
- Service de médecine nucléaire, CHRU de Besançon, université Bourgogne-Franche-Comté, 3, boulevard Alexandre-Fleming, 25030 Besançon, France
| | - T Moulin
- Unité de neurologie vasculaire, CHRU de Besançon, université Bourgogne-Franche-Comté, 3, boulevard Alexandre-Fleming, 25030 Besançon, France
| | - L Thines
- Service de neurochirurgie, CHRU de Besançon, université Bourgogne-Franche-Comté, 3, boulevard Alexandre-Fleming, 25030 Besançon, France
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TOMINAGA T, SUZUKI N, MIYAMOTO S, KOIZUMI A, KURODA S, TAKAHASHI JC, FUJIMURA M, HOUKIN K. Recommendations for the Management of Moyamoya Disease: A Statement from Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) [2nd Edition]. ACTA ACUST UNITED AC 2018. [DOI: 10.2335/scs.46.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Teiji TOMINAGA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Norihiro SUZUKI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Susumu MIYAMOTO
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Akio KOIZUMI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Satoshi KURODA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Jun C. TAKAHASHI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Miki FUJIMURA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Kiyohiro HOUKIN
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
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Corchia A, Gouvion A, Deguelte-Lardiere S, Vernet Garnier V, Raclot P, N'Guyen Y. Complications of dexamethasone prescribed for Streptococcus pneumoniae meningitis associated with cerebral vasculitis involving large- to medium-sized vessels. Rev Neurol (Paris) 2017; 174:267-268. [PMID: 29146116 DOI: 10.1016/j.neurol.2017.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 05/17/2017] [Accepted: 06/15/2017] [Indexed: 11/19/2022]
Affiliation(s)
- A Corchia
- Service de Néphrologie, Hôpital Maison-Blanche, CHU de Reims, 51092 Reims cedex, France
| | - A Gouvion
- Service de Radiologie, Hôpital Maison-Blanche, CHU de Reims, 51092 Reims cedex, France
| | - S Deguelte-Lardiere
- Service de Chirurgie générale et digestive, Hôpital Robert-Debré, CHU de Reims, rue du Général-Koenig, 51100 Reims, France
| | - V Vernet Garnier
- Laboratoire de Bactériologie, Hôpital Robert-Debré, CHU de Reims, rue du Général-Koenig, 51100 Reims, France
| | - P Raclot
- Unité de Réanimation Polyvalente, Hôpital Robert-Debré, CHU de Reims, rue du Général-Koenig, 51100 Reims, France
| | - Y N'Guyen
- Laboratoire de Virologie, EA 4684, UFR médecine Reims, 51, avenue Cognacq-Jay, 51100 Reims, France.
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30
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Chan J, D'Ambrosio Rodriguez F, Sahni D, Boucher-Berry C. Moyamoya Disease with Coexistent Hypertriglyceridemia in Pediatric Patient. Case Rep Endocrinol 2016; 2016:7974182. [PMID: 27843655 PMCID: PMC5098110 DOI: 10.1155/2016/7974182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/15/2016] [Accepted: 09/26/2016] [Indexed: 11/17/2022] Open
Abstract
Moyamoya disease is a rare chronic and progressive cerebrovascular disease of the arteries of the circle of Willis that can affect children and adults. It has been associated with multiple diseases, including immunologic, like Graves' disease, diabetes mellitus, and SLE. Hyperlipidemia has been recognized in patients with Moyamoya disease with an incidence of 27-37%. However, no case in pediatric patients has been reported of the coexistence of Moyamoya disease and hyperlipidemia. Here we present a case of a 9-year-old female diagnosed with Moyamoya disease after a stroke with incidental finding of familial hypercholesterolemia. This finding will make our patient a very unique case, since there has not been any reporting of Moyamoya disease and hypercholesterolemia association.
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Affiliation(s)
- Jacqueline Chan
- Department of Pediatric, Children's Hospital of the University of Illinois, Chicago, IL, USA
| | | | - Deepank Sahni
- Department of Pediatric, Children's Hospital of the University of Illinois, Chicago, IL, USA
| | - Claudia Boucher-Berry
- Department of Pediatric, Children's Hospital of the University of Illinois, Chicago, IL, USA
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31
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Huang Y, Cheng D, Zhang J, Zhao W. Association between the rs112735431 polymorphism of the RNF213 gene and moyamoya disease: A case-control study and meta-analysis. J Clin Neurosci 2016; 32:14-8. [PMID: 27515544 DOI: 10.1016/j.jocn.2015.11.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/29/2015] [Accepted: 11/29/2015] [Indexed: 01/08/2023]
Abstract
Ring finger protein 213 (RNF213) gene polymorphisms are thought to be significant in the etiology and pathogenesis of moyamoya disease (MMD). Due to the rarity of MMD patients, their ethnic diversity, and the use of varying methodologies, studies of the association between these polymorphisms and MMD have not been repeatable. This lack of reproducibility affects the strength of the conclusions drawn from their results. We conducted the present case-control study and meta-analysis to provide more precise estimates of the association between the rs112735431 (c.14576G>A) polymorphism and the risk of MMD. A total of 81 MMD patients and 100 healthy controls were enrolled in our case-control study. The RNF213 rs112735431 (c.14576G>A) polymorphism was genotyped using Sanger sequencing after amplification with polymerase chain reaction (PCR). The genetic algorithm (GA) genotype and A allele frequencies of RNF213 rs112735431 (c.14576G>A) (odds ratio, OR=7.10, 95% confidence interval, CI=1.51-33.43, p=0.006; OR=9.37, 95% CI=2.10-41.84, p<0.001, respectively) were significantly higher in the MMD group than those in the control group. In our meta-analysis, we assessed a total of eight case-control studies, including 985 patients and 2335 controls. Pooled ORs indicated a significant association between the presence of the rs112735431 (c.14576G>A) polymorphism and MMD risk (dominant model: OR=74.55, 95% CI=35.86-154.98, p<0.00001). Subgroup analysis based on country and sensitivity analysis verified these results. Our case-control study and meta-analysis both provide evidence of an association between the rs112735431(c.14576G>A) polymorphism in the RNF213 gene and MMD risk.
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Affiliation(s)
- Yanlan Huang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
| | - Daobin Cheng
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China.
| | - Jiede Zhang
- Department of Neurology, the National Hospital of Guangxi, 223 Mingxiu East Road, Nanning 530001, Guangxi, China
| | - Weijia Zhao
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
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Kumar RM, Saini L, Kaushik JS, Chakrabarty B, Kumar A, Gulati S. A Combination of Moyamoya Pattern and Cerebral Venous Sinus Thrombosis: A Case of Tubercular Vasculopathy. J Trop Pediatr 2015; 61:393-6. [PMID: 26136258 DOI: 10.1093/tropej/fmv036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Moyamoya vasculopathy, arising secondary to tubercular meningitis (TBM) is unusual. There have also been a few reports of cerebral venous sinus thrombosis (CVST) in TBM. A case of TBM, complicated simultaneously by Moyamoya syndrome and CVST, is being presented here. CASE A 1-year-old girl presented with febrile encephalopathy, vomiting, seizures and left hemiparesis. Cerebrospinal fluid analysis was suggestive of TBM. Extensive infarcts were noted in the magnetic resonance imaging, involving right middle cerebral artery (MCA), anterior cerebral artery and the left MCA. Magnetic resonance venogram revealed left transverse venous sinus thrombosis and magnetic resonance angiography showed bilateral moyamoya pattern of arteriopathy. Patient was started on antitubercular therapy and low molecular weight heparin. CONCLUSIONS Early vascular involvement affecting both arterial and venous structures has not hitherto been reported in CNS tuberculosis. Early recognition of secondary complications of CNS tuberculosis is crucial to prevent the morbidity and mortality associated with TBM.
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Affiliation(s)
- Ranjith M Kumar
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Lokesh Saini
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jaya Shankar Kaushik
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
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Kanoke A, Fujimura M, Niizuma K, Ito A, Sakata H, Sato-Maeda M, Morita-Fujimura Y, Kure S, Tominaga T. Temporal profile of the vascular anatomy evaluated by 9.4-tesla magnetic resonance angiography and histological analysis in mice with the R4859K mutation of RNF213, the susceptibility gene for moyamoya disease. Brain Res 2015; 1624:497-505. [PMID: 26315378 DOI: 10.1016/j.brainres.2015.07.039] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/21/2015] [Accepted: 07/23/2015] [Indexed: 11/18/2022]
Abstract
Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease with an unknown etiology. Recent genome-wide and locus-specific association studies identified the RNF213 gene (RNF213) as an important susceptibility gene of MMD among East Asian populations; however, the mechanism by which an abnormality in RNF213 leads to MMD has not yet been elucidated. Therefore, we herein generated Rnf213-knock-in mice (RNF213-KI) expressing a missense mutation in mouse Rnf213, p. R4828K, on Exon 61, corresponding to human RNF213, p. R4859K, on Exon 60, in MMD patients, and investigated whether they developed MMD. We assessed the temporal profile of intracranial arteries by 9.4-T magnetic resonance angiography (MRA) continuously in the same mouse up to 64 weeks of age. The ratios of the outer diameter of the internal carotid artery (ICA)/basilar artery (BA) and middle cerebral artery (MCA)/BA were evaluated histopathologically. The common carotid arteries (CCA) were sectioned and arterial wall thickness/thinness was evaluated by Elastica-Masson staining before and after CCA ligation, which selectively induced vascular hyperplasia. The results obtained showed that RNF213-KI grew normally, with no significant difference being observed in MRA findings or the anatomy of the circle of Willis between homozygous RNF213-KI and wild-type (Wt) littermates. Furthermore, no significant difference was noted in the diameter of the intracranial vasculature (ICA/BA; p=0.82, MCA/BA; p=0.27) or in vascular remodeling after CCA ligation. Therefore, RNF213-KI did not spontaneously develop MMD. Multiple secondary insults such as environmental factors may contribute to the onset of MMD in addition to genetic factors.
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Affiliation(s)
- Atsushi Kanoke
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ito
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroyuki Sakata
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mika Sato-Maeda
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuiko Morita-Fujimura
- Department of Molecular Biology, Tohoku University Institute of Aging and Cancer, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Khalesi M, Pezeshki Rad M, Hamedi A, Aelami MH. Moyamoya disease mimicking encephalitis. IRANIAN JOURNAL OF MEDICAL SCIENCES 2014; 39:487-90. [PMID: 25242851 PMCID: PMC4164900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/18/2013] [Accepted: 07/07/2013] [Indexed: 11/18/2022]
Abstract
Moyamoya disease is a rare vaso-occlusive illness with an unknown etiology characterized by stenosis of the internal carotid arteries with spontaneous development of a collateral vascular network. A 15-month-old girl was referred to the emergency ward of Imam Reza Hospital due to decreased level of consciousness, focal seizures and fever during the previous 24 hours with an impression of encephalitis. Physical examination revealed left side hemiparesis; however brain CT-Scan did not show any significant lesions. Initial therapy with vancomycin, ceftriaxone and acyclovir was administered. CSF analysis did not show any abnormality and the blood as well as CSF cultures results were negative. Brain MRI showed hyperintensity at right frontal and parietal regions, suggesting vascular lesion. Magnetic resonance angiography (MRA) showed bilaterally multiple torsions in vessels at the basal ganglia consistent with moyamoya vessels. In all children exhibiting encephalitis, vascular events such as moyamoya disease should be considered. Brain MRI is a critical tool for this purpose. Common causes of encephalitis such as herpes simplex should also be ruled out.
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Affiliation(s)
- Maryam Khalesi
- Department of Pediatrics, Ghaem Medical Center, Mashhad University of Medical Sciences, Mashhad, Iran;
| | - Masoud Pezeshki Rad
- Department of Radiology, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran;
| | - Abdolkarim Hamedi
- Department of Pediatrics, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hassan Aelami
- Department of Pediatrics, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Wei YC, Liu CH, Chang TY, Chin SC, Chang CH, Huang KL, Chang YJ, Peng TI, Lee TH. Coexisting diseases of moyamoya vasculopathy. J Stroke Cerebrovasc Dis 2014; 23:1344-50. [PMID: 24468071 DOI: 10.1016/j.jstrokecerebrovasdis.2013.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/10/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Several coexisting diseases have been reported in patients with moyamoya vasculopathy (MMV), but studies of quasi-moyamoya disease (quasi-MMD) are rare. This study aims to investigate the frequency of known coexisting diseases in patients with quasi-MMD and to compare quasi-MMD with moyamoya disease (MMD). METHODS Between 2000 and 2011, we retrospectively screened patients with International Classification of Diseases, Ninth Revision, code of 4375 (MMD) in the Health Information System of our hospital. The vascular images of each patient were confirmed by 2 neurologists and 1 neuroradiologist based on the diagnostic criteria of Japan Ministry of Health and Welfare. We excluded the patients with missing images and erroneous diagnosis. Demographics, coexisting diseases, laboratory data, treatment, and recurrent strokes were recorded. The eligible patients were divided into quasi-MMD and MMD groups according to the presence or absence of coexisting diseases. RESULTS MMV was found in 90 patients including 37 (41.1%) quasi-MMD and 53 (58.9%) MMD. Atherosclerosis (32.4%) and thyroid disease (29.7%) were the leading coexisting diseases in quasi-MMD. Patients with MMD became symptomatic in a bimodal age distribution, whereas patients with quasi-MMD became symptomatic in a single-peak distribution. The prognosis of recurrent strokes was similar between quasi-MMD and MMD based on Kaplan-Meier analysis. CONCLUSIONS A bimodal distribution of onset age was noted in MMD, whereas a single-peak distribution was found in quasi-MMD. Coexisting diseases were usually underevaluated but were more common than expected in patients with MMV. Atherosclerosis and thyroid diseases were the leading coexisting diseases in different preferential age.
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Affiliation(s)
- Yi-Chia Wei
- Department of Neurology, Keelung Medical Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Hung Liu
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Chang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shy-Chyi Chin
- Department of Medical Imaging and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Chang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Lun Huang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yeu-Jhy Chang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-I Peng
- Department of Neurology, Keelung Medical Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Joseph KT, Momjian-Mayor I, Vargas MI, Sztajzel R. Bilateral internal carotid artery stenosis complicating acute sinusitis. Pract Neurol 2013; 13:377-9. [DOI: 10.1136/practneurol-2012-000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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DeGaffe GH, Murphy JR, Butler IJ, Shelburne J, Heresi GP. Severe narrowing of left cavernous carotid artery associated with Fusobacterium necrophorum infection. Anaerobe 2013; 22:118-20. [DOI: 10.1016/j.anaerobe.2013.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/01/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
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Houkin K, Ito M, Sugiyama T, Shichinohe H, Nakayama N, Kazumata K, Kuroda S. Review of past research and current concepts on the etiology of moyamoya disease. Neurol Med Chir (Tokyo) 2013; 52:267-77. [PMID: 22688062 DOI: 10.2176/nmc.52.267] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Research on moyamoya disease has progressed remarkably in the past several decades. Indeed, many new facts concerning the epidemiology of the disease have been revealed and surgical treatments have been drastically improved. However, despite extensive research, the mechanism of moyamoya disease is still unknown. Consequently, the cardinal treatment of this disease has not yet been developed. For further clarification of its etiology, innovative studies are therefore indispensable. The aim of this paper is to review research on the pathogenesis of moyamoya disease to identify milestones in the direction of its true solution. Many hypotheses of the pathogenesis of moyamoya disease have been proposed in the past half century, including infection (viral and bacterial), autoimmune disorders, proteins abnormality, and gene abnormality. Some of these are now considered to be historical achievements. Others, however, can be still subjected to contemporary research. Currently, several genetic abnormalities are considered to offer the most probable hypothesis. In addition, interesting papers have been presented on the role of the endothelial progenitor cell on the pathogenesis of moyamoya disease. Intuitively, however, it appears that a single theory cannot always explain the pathogenesis of this disease adequately. In other words, the complex mechanism of several factors may comprehensively explain the formation of moyamoya disease. The "double hit hypothesis" is probably the best explanation for the complicated pathology and epidemiology of this disease.
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Affiliation(s)
- Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
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Pinardi F, Stracciari A, Spinardi L, Guarino M. Postpneumococcal Moyamoya syndrome case report and review of the postinfective cases. BMJ Case Rep 2013; 2013:bcr-2012-006726. [PMID: 23391943 DOI: 10.1136/bcr-2012-006726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Our aim was to describe a patient who experienced a postpneumococcal Moyamoya syndrome (MMS), with a great involvement of the posterior cerebral circulation, and to review the MMS postinfective cases. A 55-year-old Pakistani man with a history of pneumococcal meningitis 3 months before developed acute headache, left otalgia and body paresthesiae. Brain CT showed a right occipital ischaemic lesion. Seven days later, he developed acute left haemianopsia, haemiplegia, haemineglect and 'frontal' cognitive and behavioural symptoms. A second brain CT and MRI disclosed an increase in the occipital lesion and the appearance of a further one in the right frontal lobe. Cerebral CT and MRI-angiography were consistent with Moyamoya vessel alterations. Treatment with antiplatelets, methylprednisolone, followed by prednisone tapering, and motor rehabilitation began. Six months later, no relapses had occurred. Our case represents a delayed manifestation of postmeningitis vasculopathy. Meningitis may represent a risk factor for developing a disabling cerebrovascular disease like MMS.
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Affiliation(s)
- Federica Pinardi
- Neurological Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.
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Affiliation(s)
- Eui Kyo Seo
- Department of Neurosurgery, Ewha Womans University School of Medicine, Seoul, Korea
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Guidelines for Diagnosis and Treatment of Moyamoya Disease (Spontaneous Occlusion of the Circle of Willis). Neurol Med Chir (Tokyo) 2012; 52:245-66. [DOI: 10.2176/nmc.52.245] [Citation(s) in RCA: 601] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Liu W, Morito D, Takashima S, Mineharu Y, Kobayashi H, Hitomi T, Hashikata H, Matsuura N, Yamazaki S, Toyoda A, Kikuta KI, Takagi Y, Harada KH, Fujiyama A, Herzig R, Krischek B, Zou L, Kim JE, Kitakaze M, Miyamoto S, Nagata K, Hashimoto N, Koizumi A. Identification of RNF213 as a susceptibility gene for moyamoya disease and its possible role in vascular development. PLoS One 2011; 6:e22542. [PMID: 21799892 PMCID: PMC3140517 DOI: 10.1371/journal.pone.0022542] [Citation(s) in RCA: 426] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 06/29/2011] [Indexed: 11/19/2022] Open
Abstract
Background Moyamoya disease is an idiopathic vascular disorder of intracranial arteries. Its susceptibility locus has been mapped to 17q25.3 in Japanese families, but the susceptibility gene is unknown. Methodology/Principal Findings Genome-wide linkage analysis in eight three-generation families with moyamoya disease revealed linkage to 17q25.3 (P<10-4). Fine mapping demonstrated a 1.5-Mb disease locus bounded by D17S1806 and rs2280147. We conducted exome analysis of the eight index cases in these families, with results filtered through Ng criteria. There was a variant of p.N321S in PCMTD1 and p.R4810K in RNF213 in the 1.5-Mb locus of the eight index cases. The p.N321S variant in PCMTD1 could not be confirmed by the Sanger method. Sequencing RNF213 in 42 index cases confirmed p.R4810K and revealed it to be the only unregistered variant. Genotyping 39 SNPs around RNF213 revealed a founder haplotype transmitted in 42 families. Sequencing the 260-kb region covering the founder haplotype in one index case did not show any coding variants except p.R4810K. A case-control study demonstrated strong association of p.R4810K with moyamoya disease in East Asian populations (251 cases and 707 controls) with an odds ratio of 111.8 (P = 10−119). Sequencing of RNF213 in East Asian cases revealed additional novel variants: p.D4863N, p.E4950D, p.A5021V, p.D5160E, and p.E5176G. Among Caucasian cases, variants p.N3962D, p.D4013N, p.R4062Q and p.P4608S were identified. RNF213 encodes a 591-kDa cytosolic protein that possesses two functional domains: a Walker motif and a RING finger domain. These exhibit ATPase and ubiquitin ligase activities. Although the mutant alleles (p.R4810K or p.D4013N in the RING domain) did not affect transcription levels or ubiquitination activity, knockdown of RNF213 in zebrafish caused irregular wall formation in trunk arteries and abnormal sprouting vessels. Conclusions/Significance We provide evidence suggesting, for the first time, the involvement of RNF213 in genetic susceptibility to moyamoya disease.
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Affiliation(s)
- Wanyang Liu
- Department of Health and Environmental Sciences, Kyoto University, Kyoto, Japan
| | - Daisuke Morito
- Faculty of Life Sciences, Kyoto Sangyo University, Kyoto, Japan
| | - Seiji Takashima
- Department of Molecular Cardiology, Osaka University, Suita, Osaka, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University, Kyoto, Japan
| | - Hatasu Kobayashi
- Department of Health and Environmental Sciences, Kyoto University, Kyoto, Japan
| | - Toshiaki Hitomi
- Department of Health and Environmental Sciences, Kyoto University, Kyoto, Japan
| | - Hirokuni Hashikata
- Department of Health and Environmental Sciences, Kyoto University, Kyoto, Japan
- Department of Neurosurgery, Kyoto University, Kyoto, Japan
| | - Norio Matsuura
- Department of Health and Environmental Sciences, Kyoto University, Kyoto, Japan
| | - Satoru Yamazaki
- National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Atsushi Toyoda
- Comparative Genomics Laboratory, National Institute of Genetics, Mishima, Shizuoka, Japan
| | | | - Yasushi Takagi
- Department of Neurosurgery, Kyoto University, Kyoto, Japan
| | - Kouji H. Harada
- Department of Health and Environmental Sciences, Kyoto University, Kyoto, Japan
| | - Asao Fujiyama
- Comparative Genomics Laboratory, National Institute of Genetics, Mishima, Shizuoka, Japan
- Principles of Informatics Research Division, National Institute of Informatics, Tokyo, Japan
| | - Roman Herzig
- Palacky University Hospital, Olomouc, Czech Republic
| | - Boris Krischek
- Department of Neurosurgery, University of Tubingen, Tubingen, Germany
| | - Liping Zou
- Department of Pediatrics, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Jeong Eun Kim
- Seoul National University College of Medicine, Seoul, Korea
| | | | | | - Kazuhiro Nagata
- Faculty of Life Sciences, Kyoto Sangyo University, Kyoto, Japan
| | - Nobuo Hashimoto
- Department of Neurosurgery, Kyoto University, Kyoto, Japan
- National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- * E-mail: (NH); (AK)
| | - Akio Koizumi
- Department of Health and Environmental Sciences, Kyoto University, Kyoto, Japan
- * E-mail: (NH); (AK)
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Pati S, Muley SA, Grill MF, Coons S, Walker R. Post-streptococcal vasculopathy with evolution to Degos' disease. J Neurol Sci 2010; 300:157-9. [PMID: 21035145 DOI: 10.1016/j.jns.2010.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Revised: 09/27/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
Abstract
Degos' disease or malignant atrophic papulosis is a rare disseminated occlusive vasculopathy affecting the skin, gastrointestinal tract, central nervous system, and less often other organ systems. The exact etiology of this vasculopathy has not been established. Infections, autoimmune disease and coagulation defects have been proposed as underlying pathogenic mechanisms, but none have been confirmed. Here, we report the clinical, radiological and histopathologic features of Degos' disease in a 41-year-old man following streptococcal throat infection. Prior postulated hypothesis as post-infectious immunologic mechanism may be further supported by this case.
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Affiliation(s)
- Sandipan Pati
- Barrow Neurological Institute, 350 W Thomas Road, Phoenix, AZ 85013, United States.
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Occlusion of Internal Carotid Artery in Kimura's Disease. Case Rep Med 2010; 2010:407538. [PMID: 20224649 PMCID: PMC2833309 DOI: 10.1155/2010/407538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 01/20/2010] [Indexed: 12/02/2022] Open
Abstract
We describe a unique case of Kimura's disease in which cerebral infarction was caused by occlusion of the right internal carotid artery. A 25-year-old man with Kimura's disease was admitted to our hospital because of left hemiparesis. Computed tomography and magnetic resonance imaging of the head showed infarction in the right frontal and temporal lobes. Cerebral angiography demonstrated right internal carotid artery occlusion affecting the C1 segment, with moyamoya-like collateral vessels arising from the right opthalamic artery. Kimura's disease is a chronic disease characterized by the clinical triad of slowly enlarging subcutaneous masses with lymphoid hyperplasia in the head and neck. It often occurs in young Asian men. In our patient, the pathogenesis of internal carotid artery occlusion was unknown. There have only been a few case reports in which occlusion of the internal carotid artery was associated with autoimmune disease, and no previous cases of internal carotid occlusion associated with Kimura's disease have been reported. We suspected that occlusion of this patient's internal carotid artery may be caused by the autoimmune mechanism that underlies Kimura's disease.
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Tuberculous cerebrovascular disease: A review. J Infect 2009; 59:156-66. [DOI: 10.1016/j.jinf.2009.07.012] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 07/19/2009] [Indexed: 11/22/2022]
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Goodwin PL, Vaphiades MS, Johnson AP, Stroud CE. Bilateral Central Retinal Artery Occlusion Associated with Moyamoya Syndrome in a Sickle Cell Disease Patient. Neuroophthalmology 2009. [DOI: 10.1080/01658100701818156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Affiliation(s)
- Steven G. Pavlakis
- From the Maimonides Infants and Children’s Hospital and Mount Sinai School of Medicine, Brooklyn, NY
| | - Kim Levinson
- From the Maimonides Infants and Children’s Hospital and Mount Sinai School of Medicine, Brooklyn, NY
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