title: Clinical and angiographic features and stroke types in adult moyamoya disease.
abstract: OBJECTIVE
  This study was conducted to elucidate the association between clinical and angiographic characteristics and stroke types in adult Moyamoya disease that has been rarely evaluated.
  
  
  METHODS
  We analyzed the clinical and radiologic data obtained from a retrospective adult Moyamoya disease cohort with acute strokes, which were classified into 7 categories: large-artery infarct, hemodynamic infarct, perforator infarct, deep intracerebral hemorrhage, lobar intracerebral hemorrhage, intraventricular hemorrhage, and SAH. With conventional angiography, which was performed in the hemispheres with acute strokes, the Suzuki angiographic stage, intracranial aneurysm, major artery occlusion, and collateral vessel development were confirmed within 1 month of stroke onset.
  
  
  RESULTS
  This study included 79 patients with acute ischemic stroke and 96 patients with acute hemorrhagic stroke. The angiographic stage had a strong tendency to be more advanced in the hemorrhagic than the ischemic patients (P = .061). Intracranial aneurysms were more frequently found in the hemorrhagic than ischemic or control hemispheres (P = .002). Occlusions of the anterior cerebral artery and development of fetal-type posterior cerebral artery were more frequently observed in the hemorrhagic than the ischemic (P = .001 and .01, respectively) or control hemispheres (P = .011 and .013, respectively). MCA occlusion (P = .039) and collateral flow development, including the ethmoidal Moyamoya vessels (P = .036) and transdural anastomosis of the external carotid artery (P = .022), occurred more often in the hemorrhagic than the ischemic hemispheres. Anterior cerebral artery occlusion occurred more frequently in patients with deep intracerebral hemorrhage or intraventricular hemorrhage than with lobar intracerebral hemorrhage (P = .009).
  
  
  CONCLUSIONS
  In adult Moyamoya disease, major artery occlusion and collateral compensation occurred more often in the hemorrhagic than in the ischemic hemispheres. Thus, anterior cerebral artery occlusion with or without MCA occlusion and intracranial aneurysms may be the main contributing factors to hemorrhagic stroke in adult patients with Moyamoya disease.
authors.affiliation: From the Department of Neurosurgery (D.-K.J., Y.-M.H.), Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
authors.forename: D-K
authors.initials: DK
authors.lastname: Jang
authors.affiliation: Department of Neurosurgery (K.-S.L.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea nslk@catholic.ac.kr.
authors.forename: K-S
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery (H.K.R.), Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: H K
authors.initials: HK
authors.lastname: Rha
authors.affiliation: Department of Neurosurgery (P.-W.H.), Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
authors.forename: P-W
authors.initials: PW
authors.lastname: Huh
authors.affiliation: Department of Neurosurgery (J.-H.Y.), Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery (I.S.P.), Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
authors.forename: I S
authors.initials: IS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery (J.-G.A.), St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: J-G
authors.initials: JG
authors.lastname: Ahn
authors.affiliation: Department of Neurosurgery (J.H.S.), St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Sung
authors.affiliation: From the Department of Neurosurgery (D.-K.J., Y.-M.H.), Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
authors.forename: Y-M
authors.initials: YM
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D002533:Cerebral Angiography / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000175:diagnosis*; D015203:Reproducibility of Results; D056910:Republic of Korea; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult