Perfusion-Weighted Magnetic Resonance Imaging Used in Assessing Hemodynamics following Superficial Temporal Artery-Middle Cerebral Artery Bypass in Patients with Moyamoya Disease

2013 ◽  
Vol 35 (5) ◽  
pp. 455-460 ◽  
Author(s):  
Zhengwei Li ◽  
Ping Zhou ◽  
Zhongwei Xiong ◽  
Zhao Ma ◽  
Sheng Wang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Resonance Imaging ◽  
Weighted Magnetic Resonance Imaging

scholarly journals Paradoxical association of symptomatic cerebral edema with local hypoperfusion caused by the ‘watershed shift’ after revascularization surgery for adult moyamoya disease: a case report

2019 ◽  
Vol 12 ◽  
pp. 175628641987834 ◽  
Author(s):  
Jin Yu ◽  
Miao Hu ◽  
Lei Yi ◽  
Keyao Zhou ◽  
Jianjian Zhang ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Cerebral Edema ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Neurological Dysfunction ◽  
Fluid Replacement ◽  
Emission Computed Tomography

Superficial temporal artery–middle cerebral artery anastomosis is generally considered as an effective method in improving damage associated with intracerebral occlusions in moyamoya disease. Hemodynamic changes caused by revascularization are the cause of many postoperative complications. Of the 186 consecutive surgeries for moyamoya disease at our hospital from 2015, we herein presented one case of adult-onset moyamoya disease that manifested symptomatic local cerebral edema and local hypoperfusion caused by the ‘watershed shift’. A 67-year-old woman presented with limb numbness on the right side and underwent superficial temporal artery–middle cerebral artery anastomosis, resulting in neurological dysfunction and the formation of a reversible high-signal lesion at left frontotemporal lobes on T2-weighted images along with a decrease in perfusion values on 123I N-isopropyl-p-iodoamphetamine single-photon emission computed tomography, while the anastomotic vessel was patent on magnetic resonance angiography. This phenomenon of hypoperfusion area (left frontotemporal lobe) remote to anastomotic site (left temporal lobe area) led to the diagnosis of the ‘watershed shift’ phenomenon. In light of the hypoperfusion induced by ‘watershed shift’, the patient was treated with fluid replacement. With the gradual recovery of perfusion, the patient presented significantly improvement both on the magnetic resonance imaging findings and neurological symptoms. In conclusion, regional cerebral edema with hypoperfusion, possibly due to cerebral ischemia and the ‘watershed shift’ phenomenon, may be another novel entity that needs to be considered as a potential complication after extracranial–intracranial bypass for moyamoya disease.

Patients with moyamoya disease presenting with movement disorder

2010 ◽  
Vol 6 (6) ◽  
pp. 559-566 ◽  
Author(s):  
Paritosh Pandey ◽  
Teresa Bell-Stephens ◽  
Gary K. Steinberg
Keyword(s):  
Middle Cerebral Artery ◽  
Movement Disorder ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Movement Disorders ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Subcortical Region ◽  
Clinical Records

Moyamoya disease is a rare cerebrovascular disease characterized by idiopathic bilateral stenosis or occlusion of bilateral internal carotid arteries and the development of characteristic leptomeningeal collateral vessels at the base of the brain. Typical presentations include transient ischemic attacks or stroke, and hemorrhage. Presentation with movement disorders is extremely rare, especially in the pediatric population. The authors describe the cases of 4 children with moyamoya disease who presented with movement disorders. Among 446 patients (118 pediatric) with moyamoya disease surgically treated by the senior author, 4 pediatric patients had presented with movement disorders. The clinical records, imaging studies, surgical details, and postoperative clinical and imaging data were retrospectively reviewed. The initial presenting symptom was movement disorder in all 4 patients: chorea in 2, hemiballismus in 1, and involuntary limb shaking in 1. All the patients had watershed infarcts involving the frontal subcortical region on MR imaging. Additionally, 1 patient had a ganglionic infarct. Single-photon emission computed tomography studies showed frontoparietal cortical and subcortical hypoperfusion in all patients. Three patients had bilateral disease, whereas 1 had unilateral disease. All the patients underwent superficial temporal artery–middle cerebral artery bypass. Postoperatively, all 4 patients had complete improvement in their symptoms. The SPECT scans revealed normal perfusion in 3 patients and a small residual perfusion deficit in 1. Movement disorders are a rare presenting feature of moyamoya disease. Hypoperfusion of the frontal cortical and subcortical region was seen in all patients, and the symptomatology was attributed to ischemic dysfunction and imbalance in the cortical-subcortical-ganglionic-thalamic-cortical circuitry. Combined revascularization with superficial temporal artery–middle cerebral artery bypass and encephaloduroarteriosynangiosis leads to excellent results.

Sign in / Sign up

Export Citation Format

Share Document