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Published on: July 21, 2013
Cortical Spreading Depolarization in Moyamoya Vasculopathy: A Case Series
Patrick Dömer1,2, Simeon O A Helgers1,2, Franziska Meinert1
1Department of Neurosurgery (P.D., S.O.A.H., F.M., R.S.-P., J.W.), Carl-von-Ossietzky University Oldenburg, Germany.
Background:
Spreading depolarization describes a near-complete electrical discharge with altered local cerebral blood flow. It is described in association with acute and chronic diseases like hemorrhagic stroke or migraine. Moyamoya vasculopathy is a chronic, progressive cerebrovascular disorder leading to cerebral hypoperfusion, hemodynamically insufficient basal collateralization, and increased cortical microvascularization.
Methods:
In a prospective case series, we monitored for spontaneous spreading depolarization activity by using intraoperative laser speckle imaging for real-time visualization and measurement of cortical perfusion and cerebrovascular reserve capacity during cerebral revascularization in 4 consecutive patients with moyamoya.
Results:
Spontaneous spreading depolarization occurrence was documented in a patient with moyamoya before bypass grafting. Interestingly, this patient also exhibited a marked preoperative increase in angiographic collateral vessel formation.
Conclusions:
The spontaneous occurrence of SDs in moyamoya vasculopathy could potentially provide an explanation for localized cortical infarction and increased cortical microvascular density in these patients.
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