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Direct Visualization of Arterial Emboli in Moyamoya Syndrome
Julie G Shulman1, Samuel Snider2, Henri Vaitkevicius2
1Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
Frontiers in Neurology
|October 4, 2017
Summary
Embolization, not just hemodynamic insufficiency, may cause ischemic stroke in moyamoya syndrome. High-intensity transient signals (HITS) on transcranial Doppler (TCD) and emboli were observed, suggesting antithrombotic therapy may be beneficial.
Area of Science:
- Neurology
- Vascular Neurology
- Cerebrovascular Disease
Background:
- Moyamoya syndrome is often linked to hemodynamic insufficiency causing ischemic stroke.
- High-intensity transient signals (HITS) on transcranial Doppler (TCD) are noted in moyamoya patients, but their link to ischemia is unclear.
- Current treatments focus on improving cerebral perfusion.
Observation:
- Two moyamoya syndrome patients with ischemic symptoms were studied.
- One patient showed intraoperative emboli during bypass surgery, with HITS resolving after antiplatelet therapy.
- The other patient had HITS and embolic infarcts, with resolution using antiplatelets and anticoagulation.
Findings:
- Direct visualization and TCD evidence suggest embolization is a potential cause of brain infarction in moyamoya syndrome.
- Hemodynamic compromise may not be the sole cause of ischemia.
- HITS in moyamoya syndrome may indicate embolic events.
Implications:
- Findings challenge the sole reliance on hemodynamic management for moyamoya-related stroke.
- Suggests a potential role for antithrombotic agents in managing ischemic events.
- Highlights the need for further research into the etiology and treatment of moyamoya syndrome.
