1
|
Zhao L, Wu R, Xue B, Gao T, Liu Y, Sun Y, Guo G, Li T, Li C. Vascular architecture characters and risk factors analysis of unstable moyamoya disease. Front Neurol 2024; 15:1398007. [PMID: 38882694 PMCID: PMC11179436 DOI: 10.3389/fneur.2024.1398007] [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: 03/08/2024] [Accepted: 05/21/2024] [Indexed: 06/18/2024] Open
Abstract
Background In some MMD patients, the digital subtraction angiography (DSA) examination found, occlusion in the ipsilateral internal carotid artery or middle cerebral artery, accompanied by the formation of numerous moyamoya vessels. Conversely, the contralateral internal carotid artery or middle cerebral artery shows signs of stenosis without the presence of moyamoya vessels. Notably, cerebral perfusion studies reveal a similar or even more severe reduction in perfusion on the occluded side compared to the stenotic side. Importantly, clinical symptoms in these patients are typically attributed to ischemia caused by the stenotic side. This condition is referred to as unstable moyamoya disease (uMMD). Objective This clinical research focuses on evaluating risk factors related to MMD and developing strategies to minimize postoperative complications. The study aims to analyze vascular characteristics and identify potential risk factors in patients with uMMD. Methods The authors reviewed consecutive cases with complete clinical and radiological documentation of patients who underwent surgery between January 2018 and June 2023. Univariate analysis and multivariate logistic regression analysis were employed to understand the risk factors and prognosis of postoperative complications in uMMD. Results Postoperative complications were retrospectively analyzed in 1481 patients (aged 14 to 65). Among them, 1,429 patients were assigned to the conventional treatment group, while 52 were in the unstable moyamoya disease group. The uMMD treatment group showed a significantly higher incidence of early postoperative complications such as RIND, cerebral infarction, and cerebral hemorrhage (p < 0.05). Univariate and multivariate logistic regression analyses were conducted on the postoperative complications of 52 uMMD patients. Initial symptoms of stenosis ≤50% (univariate: p = 0.008, multivariate: p = 0.015; OR [95% CI] =23.149 [1.853-289.217]) and choosing occluded side surgery (univariate: p = 0.043, multivariate: p = 0.018; OR [95% CI] =0.059 [0.006-0.617]) were identified as significant risk factors for postoperative neurological complications. Conclusion Compared to the conventional treatment group, uMMD has higher complication rates, with vascular stenosis degree and surgical side selection identified as significant risk factors. A comprehensive understanding of preoperative clinical symptoms and vascular characteristics in moyamoya disease patients, coupled with the formulation of rational surgical plans, contributes positively to decreasing postoperative mortality and disability rates in uMMD.
Collapse
Affiliation(s)
- Liming Zhao
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ruiyu Wu
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Bingqian Xue
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Tao Gao
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yang Liu
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yuxue Sun
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Gaochao Guo
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Tianxiao Li
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Chaoyue Li
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| |
Collapse
|
2
|
Holover G, Adams D, Milligan D, Goldberg R, Rios J, Kornitzer J, Mazzola C. Moya moya vasculopathy and MECP2 duplication syndrome. Childs Nerv Syst 2024; 40:809-812. [PMID: 37804337 DOI: 10.1007/s00381-023-06139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/26/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Moya moya type vasculopathy (MMV) is a rare disorder in which there is narrowing of bilateral intracranial carotid arteries (Scott and Smith in New Engl J Med 360(12):1226-1237, 2009). MECP2 duplication syndrome (MDS) is a rare genetic disorder that is caused by genetic duplications on Xq28 chromosome (Expanding the clinical picture of the MECP2 duplication syndrome. (Lim et al. in Clin Genet 91(4):557-563, 2017). Both disorders are rare and have not been described together in association. CASE PRESENTATION Interestingly, we present a child with both MDS and MMV. Upon genetic testing, there was found to be a large, de novo duplication sequence in the patient's genome. Possible correlation between our patient's extensive genetic mutation and MMV has been evaluated. CONCLUSION Our literature search disclosed no other known patients with both MDS and MMV. Patients with MDS should be monitored carefully for signs or symptoms of vasculopathy.
Collapse
Affiliation(s)
- Gianna Holover
- School of Arts and Science, Rutgers University, New Brunswick, NJ, USA
| | - Darius Adams
- Department of Genetics, Personalized Genomic Medicine, Morristown, NJ, USA
| | - Dawn Milligan
- Department of Neurological Surgery, New Jersey Pediatric Neuroscience Institute, 131 Madison Ave 3rd Floor, Morristown, NJ, 07960, USA
| | - Rina Goldberg
- Department of Pediatric Comprehensive Epilepsy Center, Institute of Neurology and Neurosurgery, Livingston, NJ, USA
| | - Jose Rios
- Department of Radiology, Atlantic Medical Group Radiology, Morristown, NJ, USA
| | - Jeffrey Kornitzer
- Department of Neurology, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
| | - Catherine Mazzola
- Department of Neurological Surgery, New Jersey Pediatric Neuroscience Institute, 131 Madison Ave 3rd Floor, Morristown, NJ, 07960, USA.
| |
Collapse
|
3
|
Muengtaweepongsa S, Panpattanakul V. Is medical management useful in Moyamoya disease? World J Clin Cases 2024; 12:466-473. [PMID: 38322475 PMCID: PMC10841962 DOI: 10.12998/wjcc.v12.i3.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/24/2023] [Accepted: 01/05/2024] [Indexed: 01/18/2024] Open
Abstract
Moyamoya disease (MMD), characterized by progressive internal carotid artery stenosis and collateral vessel formation, prompts cerebral perfusion complications and is stratified into idiopathic and Moyamoya syndrome subtypes. A multifaceted approach toward MMD management addresses cerebral infarctions through revascularization surgery and adjunctive medical therapy, while also navigating risks such as intracranial hemorrhage and cerebral infarction resulting from arterial stenosis and fragile collateral vessels. Addressing antithrombotic management reveals a potential role for treatments like antiplatelet agents and anticoagulants, despite the ambiguous contribution of thrombosis to MMD-related infarctions and the critical balance between preventing ischemic events and averting hemorrhagic complications. Transcranial doppler has proven useful in thromboembolic detection, despite persisting challenges concerning the efficacy and safety of antithrombotic treatments. Furthermore, antihypertensive interventions aim to manage blood pressure meticulously, especially during intracerebral hemorrhage, with recommendations and protocols varying based on the patient's hypertension status. Additionally, lipid-lowering therapeutic strategies, particularly employing statins, are appraised for their possible beneficial role in MMD management, even as comprehensive data from disease-specific clinical trials remains elusive. Comprehensive guidelines and protocols to navigate the multifaceted therapeutic avenues for MMD, while maintaining a delicate balance between efficacy and safety, warrant further meticulous research and development. This protocol manuscript seeks to elucidate the various aspects and challenges imbued in managing and navigating through the complex landscape of MMD treatment.
Collapse
Affiliation(s)
- Sombat Muengtaweepongsa
- Center of Excellence in Stroke, Division of Neurology, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, Klonglaung 12120, Pathum Thani, Thailand
| | - Vatcharasorn Panpattanakul
- Division of Neurology, Department of Internal Medicine, School of Medicine, University of Phayao, Phayao 56000, Thailand
| |
Collapse
|
4
|
Ayub Jajja S, Kunwar D, Ahmed S, Akbar A, Anjum AS, Anjum S. Moyamoya disease in an adolescent with subarachnoid hemorrhage: a case report. Int J Neurosci 2023:1-5. [PMID: 37996399 DOI: 10.1080/00207454.2023.2287980] [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: 05/17/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE/AIM OF THE STUDY This study aims to present a case of Moyamoya disease (MMD) in an adolescent who experienced a subarachnoid hemorrhage (SAH). The purpose is to underscore the importance of considering MMD as a potential cause of SAH in adolescents, particularly in the absence of common causes such as trauma or aneurysmal rupture. The case further highlights the significance of early identification and appropriate management to prevent further complications and improve patient outcomes. MATERIALS AND METHODS The diagnosis was initially based on findings from a CT angiography and later confirmed through magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI). RESULTS The case study demonstrates the effectiveness of utilizing MRA and MRI in diagnosing MMD in adolescents. It emphasizes the challenges in areas with limited resources where advanced imaging techniques like digital subtraction angiography (DSA) may not be readily accessible or affordable. The gold standard for MMD diagnosis, DSA, is acknowledged, but the study underscores the importance of alternative imaging methods in resource-constrained settings. CONCLUSION In conclusion, this case underscores the importance of considering Moyamoya disease as a potential etiology for subarachnoid hemorrhage in adolescents, particularly when common causes are absent. The study highlights the crucial role of MRA and MRI in the diagnosis of MMD, emphasizing their significance in areas with limited resources. Early identification and appropriate management are essential for preventing complications and improving patient outcomes, acknowledging the challenges associated with the accessibility of gold standard diagnostic techniques in certain settings.
Collapse
Affiliation(s)
| | - Digbijay Kunwar
- Internal Medicine, Nishtar Medical University, Multan, Pakistan
| | - Shahroze Ahmed
- Internal Medicine, Nishtar Medical University, Multan, Pakistan
| | - Anum Akbar
- Department of Pediatrics, University of Nebraska Medical Center, Nebraska, USA
| | | | - Sadia Anjum
- Radiology, Nishtar Medical University, Multan, Pakistan
| |
Collapse
|
5
|
Filimonova E, Martirosyan A, Ovsiannikov K, Pashkov A, Rzaev J. White and Gray Matter Perfusion in Children with Moyamoya Angiopathy after Revascularization Surgery. Pediatr Neurosurg 2023; 58:197-205. [PMID: 37379805 DOI: 10.1159/000531719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Surgical revascularization is very effective in patients with moyamoya angiopathy (MMA) and leads to improvements in cortical perfusion parameters. However, changes in white matter hemodynamics are still underestimated. To date, only a few studies have examined brain perfusion changes within deep white matter after bypass surgery in patients with MMA. METHODS Ten children with MMA were evaluated using the CT perfusion technique before and after revascularization surgery. Brain perfusion parameters within gray and white matter were compared before and after surgery. The correlations between the perfusion parameters before surgery and the Suzuki stage, as well as between the perfusion parameters and the cognitive scores, were also evaluated. RESULTS Brain perfusion parameters improved significantly in both gray matter (predominantly due to cerebral blood flow within the anterior circulation, p < 0.01) and white matter (predominantly due to cerebral blood volume within the semiovale centrum, p < 0.001). We revealed that the pattern of improvement in perfusion in white matter differed from the pattern of improvement in perfusion in gray matter. Significant correlations were revealed between the Suzuki stage before surgery and the perfusion parameters within the posterior cerebral artery circulation (adjusted p < 0.05). There were also significant correlations between cognitive scores and brain perfusion parameters in gray matter and white matter (adjusted p < 0.05). CONCLUSIONS The perfusion parameters of gray matter and white matter in the brain improve differently after bypass surgery in patients with MMA. Different hemodynamics within these compartments could explain this.
Collapse
Affiliation(s)
- Elena Filimonova
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk, Russian Federation
- Department of neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - Azniv Martirosyan
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk, Russian Federation
| | - Konstantin Ovsiannikov
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk, Russian Federation
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogov Str. 1, Novosibirsk, Russian Federation
| | - Anton Pashkov
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk, Russian Federation
- Department of Clinical Psychology, Lab of molecular and genetic studies, South Ural State University, Chelyabinsk, Russian Federation
| | - Jamil Rzaev
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk, Russian Federation
- Department of neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russian Federation
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogov Str. 1, Novosibirsk, Russian Federation
| |
Collapse
|
6
|
Shi Z, Wu L, Wang Y, Zhang H, Yang Y, Hang C. Risk factors of postoperative cerebral hyperperfusion syndrome and its relationship with clinical prognosis in adult patients with moyamoya disease. Chin Neurosurg J 2023; 9:10. [PMID: 37013602 PMCID: PMC10069070 DOI: 10.1186/s41016-023-00321-8] [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: 04/14/2022] [Accepted: 02/28/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND To investigate the incidence, risk factors, and clinical prognosis of cerebral hyperperfusion syndrome (CHS) after superficial temporal artery-middle cerebral artery anastomosis combined with encephalo-duro-arterio-synangiosis (STA-MCA/EDAS) in adult patients with moyamoya disease (MMD). METHODS The clinical data of 160 adult patients with MMD treated by STA-MCA/EDAS from January 2016 to January 2017 were retrospectively analyzed. According to CHS diagnosis, MMD patients were divided into CHS and non-CHS group. Univariate and multivariate analysis of risk factors and Kaplan-Meier curve of stroke-free survival for CHS were performed. RESULTS A total of 12 patients (7.5%) developed postoperative CHS, of which 4 patients (2.5%) presented with cerebral hemorrhage. Univariate and multivariate analysis showed moyamoya vessel on the surgical hemisphere (OR = 3.04, 95% CI = 1.02-9.03, P = 0.046) and left operated hemisphere (OR = 5.16, 95% CI = 1.09-21.34, P = 0.041) were independent risk factors for CHS. The other variables, such as age, gender, presentation, hypertension, diabetes, smoking, mean mRS score on admission, modified Suzuki stage and pre-infarction stage on surgical hemisphere, and bypass patency, had no association with postoperative CHS (P > 0.05). At final follow-up with average 38 months, there were 18 out of 133 patients (13.5%, 4.91% per person year) presented with newly developed complications. There was no significant difference between newly developed complications, mean mRS scores, and Kaplan-Meier curve of stroke-free survival in patients with and without CHS (P > 0.05). CONCLUSION The concentration of moyamoya vessels and left operated hemisphere was independent risk factors for CHS, which could not affect the clinical prognosis if treated timely and properly. The current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.
Collapse
Affiliation(s)
- Zhiyong Shi
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, Jiangsu Province, MN 210008, People's Republic of China
| | - Lingyun Wu
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, Jiangsu Province, MN 210008, People's Republic of China
| | - Yi Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, Jiangsu Province, MN 210008, People's Republic of China
| | - Huasheng Zhang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, Jiangsu Province, MN 210008, People's Republic of China
| | - Yongbo Yang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, Jiangsu Province, MN 210008, People's Republic of China.
| | - Chunhua Hang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, Jiangsu Province, MN 210008, People's Republic of China
| |
Collapse
|
7
|
Chavan G, Chavan A, Nagdev G, Aurangabadkar GM. Moyamoya Disease From an Otolaryngologist’s Perspective: A Rare Case. Cureus 2022; 14:e28108. [PMID: 36127999 PMCID: PMC9480859 DOI: 10.7759/cureus.28108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
Moyamoya disease is characterized by narrowing of cerebral blood vessels and is progressive in nature. We present the case of a 21-year-old female patient who was a known case of Down’s syndrome and presented with right-sided facial muscle weakness and was initially suspected of having cholesteatoma, but no evidence for the same was found after extensive radiological investigations. The suspicion of a central nervous system pathology was raised due to the clinical findings of dysphasia and supranuclear facial palsy. Magnetic-resonance angiography (MRA) was suggestive of findings of early Moyamoya disease. After a Neurologist consultation, the patient was started on conservative management with anti-platelet drugs and Statins and had symptomatic improvement. The patient was advised regular follow-up and had no fresh episodes of similar complaints.
Collapse
|
8
|
Mystery(n) Phenotypic Presentation in Europeans: Report of Three Further Novel Missense RNF213 Variants Leading to Severe Syndromic Forms of Moyamoya Angiopathy and Literature Review. Int J Mol Sci 2022; 23:ijms23168952. [PMID: 36012218 PMCID: PMC9408709 DOI: 10.3390/ijms23168952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/20/2022] Open
Abstract
Moyamoya angiopathy (MMA) is a rare cerebral vasculopathy in some cases occurring in children. Incidence is higher in East Asia, where the heterozygous p.Arg4810Lys variant in RNF213 (Mysterin) represents the major susceptibility factor. Rare variants in RNF213 have also been found in European MMA patients with incomplete penetrance and are today a recognized susceptibility factor for other cardiovascular disorders, from extracerebral artery stenosis to hypertension. By whole exome sequencing, we identified three rare and previously unreported missense variants of RNF213 in three children with early onset of bilateral MMA, and subsequently extended clinical and radiological investigations to their carrier relatives. Substitutions all involved highly conserved residues clustered in the C-terminal region of RNF213, mainly in the E3 ligase domain. Probands showed a de novo occurring variant, p.Phe4120Leu (family A), a maternally inherited heterozygous variant, p.Ser4118Cys (family B), and a novel heterozygous variant, p.Glu4867Lys, inherited from the mother, in whom it occurred de novo (family C). Patients from families A and C experienced transient hypertransaminasemia and stenosis of extracerebral arteries. Bilateral MMA was present in the proband’s carrier grandfather from family B. The proband from family C and her carrier mother both exhibited annular figurate erythema. Our data confirm that rare heterozygous variants in RNF213 cause MMA in Europeans as well as in East Asian populations, suggesting that substitutions close to positions 4118–4122 and 4867 of RNF213 could lead to a syndromic form of MMA showing elevated aminotransferases and extracerebral vascular involvement, with the possible association of peculiar skin manifestations.
Collapse
|
9
|
Wu H, Xia C, Li R, Tao C, Tang Q, Hu W. Correlation Between Apelin and Collateral Circulation in Patients with Middle Cerebral Artery Occlusion and Moyamoya Disease. Int J Gen Med 2022; 15:699-709. [PMID: 35082519 PMCID: PMC8784270 DOI: 10.2147/ijgm.s341015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/14/2021] [Indexed: 01/12/2023] Open
Abstract
Background and Objectives Moyamoya disease (MMD) is a unique cerebrovascular occlusive disease with abnormal vascular hyperplasia, which causes cerebrovascular accidents like intracranial arteriosclerosis. This study aimed to explore whether plasma apelin levels are related to good collateral circulation in ischemic diseases, which may be higher in patients with MMD than middle cerebral artery (MCA) occlusion or healthy controls, and may have a connection with the MMD grades. Methods We recruited 68 MMD patients and 25 MCA occlusion patients diagnosed by angiography, including 29 patients without cerebrovascular problems as controls. We examined the plasma apelin, serum nitric oxide (NO), and vascular endothelial growth factor (VEGF) levels of all subjects by ELISA kit. We compared the relationship between apelin, NO, and VEGF in the blood of three groups, to explore the relationship. We also investigated whether the plasma apelin-13, apelin-17, and apelin-36 levels correlate with the MMD classification. Results Univariate analyses indicated that the MMD group had the higher plasma apelin-13, apelin-17, apelin-36, and serum NO levels than the MCA occlusion and healthy control groups. Binary logistic regression analyses further showed that the apelin-13 level was substantially higher in MMD patients than in MCA occlusion patients. Patients with MMD were significantly younger than patients with MCA occlusion by their mean ages. Linear regression analyses were performed to compare apelin levels between different grades of the patients with MMD. Apelin-13, apelin-17, and apelin-36 levels increased with the gradual increase of compensation grades level independent of NO and VEGF. Apelin-13 and apelin-36 showed a positive effect on the compensation scores in MMD. Conclusion Our study demonstrated that apelin-13 was significantly increased in patients with MMD than patients with MCA occlusion independent of NO and VEGF. Moreover, plasma apelin-13, apelin-17, and apelin-36 levels increase with the grades of MMD.
Collapse
Affiliation(s)
- Hanlin Wu
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Chengyu Xia
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Rui Li
- Department of Neurology, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Chunrong Tao
- Department of Neurology, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Qiqiang Tang
- Department of Neurology, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Wei Hu
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
- Correspondence: Wei Hu; Qiqiang Tang Email ;
| |
Collapse
|
10
|
Xian WB, Zhang XS, Shi XC, Luo GH, Yi C, Pei Z. Corticostriatal Hypermetabolism in Moyamoya Disease-Induced Hemichorea: Two Case Reports and a Literature Review. Front Neurol 2021; 12:649014. [PMID: 34248815 PMCID: PMC8266195 DOI: 10.3389/fneur.2021.649014] [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: 01/03/2021] [Accepted: 05/26/2021] [Indexed: 12/03/2022] Open
Abstract
Moyamoya disease (MMD) is a rare cause of chorea, and its pathophysiological mechanism remains unclear. We explore the use of cerebral positron emission tomography (PET) to study brain functional connectivity in 2 patients with MMD-induced hemichorea. Abnormal metabolism of brain was analyzed by 18F-fluorodeoxyglucose (18F-FDG) PET images. Dopamine transporters (DAT) PET evaluated the integrity of the cerebral dopamine system. A comprehensive systemic literature search of the PubMed database was also conducted. The 18F-FDG imaging of our patients showed no responsible hypometabolism in affected brain areas, while hypermetabolism in the affected caudate nucleus, putamen and fronto-parietal areas could be seen. DAT PET imaging was normal in patient 1 (a 23-year-old woman), while remarkably reduced DAT binding was seen in the left striatum of patient 2 (a 48-year-old woman). The literature review of 9 publications revealed that 11 patients who underwent single photon emission computed tomography (SPECT) showed cerebral hypoperfusion in the cortex and subcortical area; 18F-FDG PET was performed in 3 cases, which revealed hypermetabolism in the affected striatum in 2 cases. These findings suggest that the striatal and cortical hypermetabolism in the first patient result from underactivity in indirect pathway from basal ganglia-thalamocortical circuits, causing increased activity of excitatory glutamatergic thalamostriatal and thalamocortical projection neurons. The collateral vessels in the basal ganglia might lead to disruption of normal basal ganglia signaling. A dominant left hemisphere with corpus callosal connections to the right basal ganglia resulting into left hemichorea is the most probable explanation for the second patient. We have identified abnormal functional connectivity in basal ganglia-thalamocortical circuits in patients with MMD-induced chorea highlighting the corticostriatal pathway plays an important role in the pathogenesis of MMD-induced chorea.
Collapse
Affiliation(s)
- Wen-Biao Xian
- 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, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Xiang-Song Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin-Chong Shi
- Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gan-Hua Luo
- Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chang Yi
- Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhong Pei
- 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, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| |
Collapse
|
11
|
Etli M, Karahan O. Unusual presentation of moyamoya disease with popliteal involvement: case report and review of the literature. J Vasc Bras 2021; 20:e20200216. [PMID: 34211538 PMCID: PMC8218857 DOI: 10.1590/1677-5449.200216] [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] [Indexed: 11/21/2022] Open
Abstract
Moyamoya disease is a rare disorder that involves the cerebrovascular system. Usually, it leads to occlusion of the arteries of the cerebral system and causes cerebral circulatory complaints. A 48-year-old female patient was admitted to our clinic with intermittent claudication in both legs. Biphasic and monophasic waveform patterns were detected bilaterally in distal (trifurcation arteries) lower extremities with Doppler sonography. The patient therefore underwent systemic vascular examination. Computed tomography angiography revealed bilateral carotid occlusion at the level of supraclinoid segments, and opacifications were detected at the distal segments of the bilateral anterior cerebellar and middle cerebellar arteries. The patient was diagnosed with moyamoya disease, and anticoagulant treatment was started. In conclusion, most previous reports have presented the cerebrovascular involvement of moyamoya disease. However, this disease can involve different peripheral vascular systems and careful and systemic vascular examination is necessary for an exact diagnosis.
Collapse
Affiliation(s)
- Mustafa Etli
- Alaaddin Keykubat University, Medical School, Alanya/Antalya, Turkey
| | - Oguz Karahan
- Alaaddin Keykubat University, Medical School, Alanya/Antalya, Turkey
| |
Collapse
|
12
|
Matano F, Murai Y, Watanabe A, Shirokane K, Igarashi T, Shimizu K, Shimada T, Morita A. Case Report: A Case of Moyamoya Syndrome Associated With Multiple Endocrine Neoplasia Type 2A. Front Endocrinol (Lausanne) 2021; 12:703410. [PMID: 34858321 PMCID: PMC8632216 DOI: 10.3389/fendo.2021.703410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
To the best of our knowledge, we report a case of MEN2A complicated by moyamoya syndrome. A 52-year-old woman presented with vertigo. Magnetic resonance angiography (MRA) revealed bilateral supraclinoid stenosis of the internal carotid artery and abnormal moyamoya-like vessels around the basal ganglia. She had a heterozygous variant of RNF213, which is the susceptibility gene for moyamoya disease. She had also previously received diagnoses of medullary thyroid carcinoma (MTC) at age 23 and left-sided pheochromocytoma (PHEO) at age 41. Genetic testing revealed heterozygosity for a mutation at codon 634 in exon 11 (TGC-TTC mutation; p.Cys634Phe) of the Ret gene. Intracranial vascular stenosis may have been caused by a genetic mutation of RNF213 and hypersecretion of catecholamines by MEN2A. Physicians should recognize that MEN2A can be present with moyamoya syndrome.
Collapse
Affiliation(s)
- Fumihiro Matano
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | - Yasuo Murai
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
- *Correspondence: Yasuo Murai,
| | - Atsushi Watanabe
- Division of Clinical Genetics, 3 Support Center for Genetic Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | | | - Takehito Igarashi
- Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan
| | - Kazuo Shimizu
- Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan
| | - Takashi Shimada
- Division of Clinical Genetics, 3 Support Center for Genetic Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| |
Collapse
|