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Neurorehabilitation outcome in moyamoya disease
D P Moore1, M Y Lee, S N Macciocchi
1Department of Physical Medicine and Rehabilitation, School of Medicine, East Carolina University, Greenville, NC 27858, USA.
Abstract:
Moyamoya is a disease characterized by occlusion of the internal carotid, anterior, and middle cerebral arteries with associated rich collateral flow that presents a cloudy appearance on angiogram resembling a puff of smoke. The disease is most often progressive with associated hemiparesis and cognitive impairment. The functional outcome of patients with moyamoya is not well described in the literature. We describe four women (ages 25-36) who were transferred to a rehabilitation service after an average 17 days (12-26 days) in an acute care setting. Initial functional impairment was estimated using the Functional Independence Measure (FIM) score after discharge from inpatient rehabilitation (23-53 days) and was compared to the Uniform Data System for Medical Rehabilitation (UDSMR) for "first stroke" patients. Average admission FIM scores were similar in the two groups. The patients with moyamoya had a higher discharge FIM, longer length of stay, and slower rate of progress. Data on long-term survival and functional level would be useful, but it appears patients with moyamoya disease may benefit from rehabilitation oriented toward neurological deficits.
Insights
Moyamoya disease patients showed improved functional independence after rehabilitation, despite a slower recovery rate compared to general stroke patients. This suggests targeted neurological rehabilitation is beneficial for moyamoya outcomes.
Area of Science:
- Neurology
- Rehabilitation Medicine
Background:
- Moyamoya disease involves progressive arterial occlusion in the brain, leading to hemiparesis and cognitive decline.
- Functional outcomes for moyamoya disease patients are not extensively documented in medical literature.
Observation:
- Four women (ages 25-36) with moyamoya disease were studied post-acute care.
- Functional Independence Measure (FIM) scores were used to assess impairment upon discharge from inpatient rehabilitation.
Findings:
- Moyamoya patients had similar initial FIM scores to general stroke patients but achieved higher discharge FIM scores.
- Rehabilitation for moyamoya patients involved a longer length of stay and a slower rate of progress.
Implications:
- Moyamoya disease patients may significantly benefit from specialized rehabilitation focused on neurological deficits.
- Further research on long-term survival and functional levels in moyamoya disease is warranted.