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Related Experiment Videos

Hemorrhagic type moyamoya disease

N Saeki1, S Nakazaki, M Kubota

  • 1Department of Neurological Surgery, Chiba University, School of Medicine, Japan.

Clinical Neurology and Neurosurgery
|December 31, 1997
PubMed
Summary

Hemorrhagic Moyamoya disease frequently causes rebleeding, particularly in women, leading to poorer outcomes. Controlling blood pressure is crucial for preventing rebleeding and improving prognosis in these patients.

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Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Moyamoya disease is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries.
  • Hemorrhagic type Moyamoya disease presents unique challenges in diagnosis and management.
  • Understanding the patterns and outcomes of bleeding is crucial for patient care.

Observation:

  • Analysis of 20 hemorrhagic Moyamoya disease cases revealed common bleeding sites including basal ganglia (40%), intraventricular hemorrhage (30%), and thalamic hemorrhage (15%).
  • Magnetic resonance imaging (MRI) effectively identified old bleeding sites and their changes over time.
  • A significant 35% of patients experienced rebleeding within a 6.2-year follow-up period.

Findings:

  • Rebleeding significantly worsened outcomes, with good outcome rates dropping from 60% after the first bleed to 40% after rebleeding.

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  • Mortality rates increased from 5% after the first bleed to 25% after rebleeding.
  • Factors associated with rebleeding and poorer outcomes included female sex, massive intracranial hemorrhage (ICH), and early recurrence.

    • Implications:

    • Preventing rebleeding is paramount for improving the prognosis of hemorrhagic Moyamoya disease.
    • Blood pressure control is critical in both acute and chronic management.
    • Bypass surgery may offer less benefit for the hemorrhagic type compared to the ischemic type, warranting further investigation.