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Hemorrhage predisposing to cerebral infarction in children with moyamoya disease

Mubeen F Rafay1, Sabrina E Smith, Peter Dirks

  • 1Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.

Pediatric Neurology
|May 2, 2006
PubMed

Insights

Hemorrhagic moyamoya disease in children can lead to cerebral infarction after intraventricular hemorrhage. Increased intracranial pressure may be a risk factor for these ischemic complications, warranting further investigation.

Area of Science:

  • Pediatric Neurology
  • Neurovascular Diseases
  • Cerebrovascular Surgery

Background:

  • Moyamoya disease is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries.
  • Hemorrhagic moyamoya disease presents a distinct clinical challenge, particularly in pediatric populations.
  • Intraventricular hemorrhage is a known complication, but its association with subsequent ischemic events requires further elucidation.

Observation:

  • Two pediatric patients diagnosed with hemorrhagic moyamoya disease developed cerebral infarction post-intraventricular hemorrhage.
  • Ischemic events occurred 15 and 2 days after the initial hemorrhage diagnosis.
  • Computed tomographic scans revealed signs of increased intracranial pressure preceding the ischemic complications.

Findings:

  • Increased intracranial pressure, in the context of intraventricular hemorrhage, may serve as a significant risk factor for cerebral infarction in pediatric moyamoya disease.
  • The absence of other identifiable provocative factors like hypoperfusion highlights the potential role of elevated intracranial pressure.

Implications:

  • This finding suggests a critical need to monitor and manage intracranial pressure closely in pediatric patients with hemorrhagic moyamoya disease and intraventricular hemorrhage.
  • Further research is essential to establish optimal acute management strategies for preventing ischemic complications in this vulnerable patient group.
  • Understanding the interplay between hemorrhage, intracranial pressure, and ischemia is crucial for improving outcomes in moyamoya disease.

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