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Case of de novo cerebral microbleeds in ischemic-type pediatric moyamoya disease
Kohei Inoue1, Akihiko Momozaki1, Takashi Furukawa1
1Department of Neurosurgery, Saga University, Saga, Japan.
Background:
Studies on pediatric patients with moyamoya disease who presented with de novo cerebral microbleeds (CMBs) are extremely rare.
Case Description:
Herein, we report a 7-year-old boy with moyamoya disease who had de novo CMBs during treatment. He presented with transient left-side motor weakness and was diagnosed with moyamoya disease. He underwent revascularization surgery on the right cerebral hemisphere. Six months after the surgery, he presented with transient right-side motor weakness and MRA revealed progression of stenosis in the left middle cerebral artery. After another 3 months, three de novo CMBs were identified. He underwent revascularization surgery on the left side. The symptom disappeared completely after surgery and no additional de novo CMBs were identified 1 year after surgery.
Conclusion:
This is the first report on de novo CMBs in pediatric patients. Although the significance of de novo CMBs in pediatric patients is completely unknown, attention should be paid to not only ischemic stroke but also hemorrhagic stroke. Although the short-term course is good in the current case, follow-up period is too short to assess for rebleeding and long-term follow-up is still important. Further, more cases should be collected.
Insights
This case study reports the first instance of de novo cerebral microbleeds (CMBs) in a pediatric moyamoya disease patient. The findings highlight the need to monitor for hemorrhagic stroke alongside ischemic events in these young patients.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Moyamoya disease is a rare cerebrovascular disorder.
- De novo cerebral microbleeds (CMBs) are uncommon in pediatric moyamoya disease.
- Existing literature lacks comprehensive data on de novo CMBs in pediatric populations.
Observation:
- A 7-year-old boy with moyamoya disease developed de novo CMBs during treatment.
- The patient experienced transient hemiparesis, indicative of cerebrovascular events.
- Magnetic resonance angiography (MRA) showed disease progression despite initial revascularization surgery.
Findings:
- The patient developed three de novo CMBs after progression of stenosis.
- Symptomatic improvement and resolution of de novo CMBs were observed after bilateral revascularization surgery.
- This case represents the first reported instance of de novo CMBs in a pediatric moyamoya disease patient.
Implications:
- The significance of de novo CMBs in pediatric moyamoya disease remains unclear.
- Clinicians should consider both ischemic and hemorrhagic stroke risks in pediatric moyamoya disease.
- Long-term follow-up is crucial to assess rebleeding risk and long-term outcomes in pediatric patients with de novo CMBs.
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