Pediatric moyamoya disease presenting with intracerebral hemorrhage--report of three cases and review of the literature.
Intracerebral hemorrhage in patients with moyamoya disease is rare in children. We report three unique cases of pediatric moyamoya disease with hemorrhagic onset. Two 7-year-old girls and a 9-year-old girl were admitted to our hospital because of intracerebral hemorrhage associated with angiographically verified moyamoya disease. Two of them did not demonstrate either an ischemic episode or cerebral infarct on the magnetic resonance images. A decreased regional cerebral blood flow was revealed on single photon emission computed tomography in two patients, who developed cerebral infarction in the acute stage following hemorrhage. They underwent superficial temporal artery-middle cerebral artery anastomoses combined with encephalo-myo-synangiosis, and have not experienced any further ischemic episodes thereafter. Hemodynamic insufficiency associated with moyamoya disease could cause intracerebral hemorrhage even in children. Adequate management in the acute stage of hemorrhage and revascularization surgery are recommended to prevent cerebral infarction, which may easily occur in pediatric patients with moyamoya disease.
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. ksuyama@nagasaki-u.ac.jp
Kazuhiko
K
Suyama
Koichi
K
Yoshida
Hideaki
H
Takahata
Keisuke
K
Toda
Hiroshi
H
Baba
Yasunari
Y
Ishikawa
Makoto
M
Hirose
Izumi
I
Nagata
D002545:Brain Ischemia / Q000209:etiology / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology*; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation; D002648:Child; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009072:Moyamoya Disease / Q000150:complications / Q000473:pathology* / Q000601:surgery; D019635:Neurosurgical Procedures; D010291:Paresis / Q000209:etiology; D011183:Postoperative Complications / Q000473:pathology; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed