Coexisting diseases of moyamoya vasculopathy.
BACKGROUND
Several coexisting diseases have been reported in patients with moyamoya vasculopathy (MMV), but studies of quasi-moyamoya disease (quasi-MMD) are rare. This study aims to investigate the frequency of known coexisting diseases in patients with quasi-MMD and to compare quasi-MMD with moyamoya disease (MMD).


METHODS
Between 2000 and 2011, we retrospectively screened patients with International Classification of Diseases, Ninth Revision, code of 4375 (MMD) in the Health Information System of our hospital. The vascular images of each patient were confirmed by 2 neurologists and 1 neuroradiologist based on the diagnostic criteria of Japan Ministry of Health and Welfare. We excluded the patients with missing images and erroneous diagnosis. Demographics, coexisting diseases, laboratory data, treatment, and recurrent strokes were recorded. The eligible patients were divided into quasi-MMD and MMD groups according to the presence or absence of coexisting diseases.


RESULTS
MMV was found in 90 patients including 37 (41.1%) quasi-MMD and 53 (58.9%) MMD. Atherosclerosis (32.4%) and thyroid disease (29.7%) were the leading coexisting diseases in quasi-MMD. Patients with MMD became symptomatic in a bimodal age distribution, whereas patients with quasi-MMD became symptomatic in a single-peak distribution. The prognosis of recurrent strokes was similar between quasi-MMD and MMD based on Kaplan-Meier analysis.


CONCLUSIONS
A bimodal distribution of onset age was noted in MMD, whereas a single-peak distribution was found in quasi-MMD. Coexisting diseases were usually underevaluated but were more common than expected in patients with MMV. Atherosclerosis and thyroid diseases were the leading coexisting diseases in different preferential age.
Department of Neurology, Keelung Medical Center, Chang Gung Memorial Hospital, Keelung, Taiwan.
Yi-Chia
YC
Wei
Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Chi-Hung
CH
Liu
Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ting-Yu
TY
Chang
Department of Medical Imaging and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Shy-Chyi
SC
Chin
Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan.
Chien-Hung
CH
Chang
Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Kuo-Lun
KL
Huang
Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Yeu-Jhy
YJ
Chang
Department of Neurology, Keelung Medical Center, Chang Gung Memorial Hospital, Keelung, Taiwan.
Tsung-I
TI
Peng
Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: thlee@adm.cgmh.org.tw.
Tsong-Hai
TH
Lee
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000453:epidemiology*; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000453:epidemiology*; D055815:Young Adult
Moyamoya disease; Taiwan; atherosclerosis; hyperthyroidism; moyamoya syndrome; moyamoya vasculopathy; quasi-moyamoya disease; stroke