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Changing ischaemic lesion patterns in adult moyamoya disease

J-M Kim1, S-H Lee, J-K Roh

  • 1Department of Neurology, Seoul National University Hospital, Jongno-gu, Seoul, 110-744, Republic of Korea.

Journal of Neurology, Neurosurgery, and Psychiatry
|May 3, 2008
PubMed
Abstract

Insights

Adult moyamoya disease (MMD) patients with severe disease show ischaemic strokes in the brain cortex and posterior regions. Stroke mechanisms are linked to haemodynamic compromise, suggesting lesion patterns evolve with arterial involvement.

Area of Science:

  • Neurology
  • Neuroimaging
  • Vascular Neurology

Background:

  • Ischaemic stroke is a common complication in adult moyamoya disease (MMD).
  • The correlation between MMD lesion patterns and disease severity requires further investigation.
  • Understanding these patterns is crucial for predicting stroke risk and guiding treatment.

Purpose of the Study:

  • To investigate the relationship between ischaemic stroke lesion patterns and disease severity in adult moyamoya disease.
  • To compare lesion locations (cortical vs. subcortical, anterior vs. posterior) with MMD severity (Suzuki's grade) and perfusion status (SPECT).

Main Methods:

  • Retrospective analysis of 32 adult MMD patients with first-ever ischaemic stroke.
  • Lesion categorization by location: cortical/subcortical and anterior/posterior involvement.
  • Comparison of lesion patterns with intracranial artery involvement (Suzuki's grade) and SPECT-derived perfusion status.

Main Results:

  • Cortical and posterior ischaemic lesions were significantly associated with greater MMD severity (higher Suzuki grades).
  • Patients with cortical involvement had higher Suzuki grades (4.17) than subcortical (2.70).
  • Posterior involvement showed higher Suzuki grades (4.50) compared to anterior (2.83); most patients (83.3%) had larger perfusion defects than MRI-defined lesions.

Conclusions:

  • Advanced adult MMD is linked to ischaemic strokes affecting the cortex and posterior brain regions.
  • Haemodynamic compromise is a primary stroke mechanism in these patients.
  • The pattern of ischaemic stroke lesions in MMD may evolve with the progression of intracranial arterial disease.

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