title: Cerebrovascular Events During Pregnancy and Puerperium Resulting from Preexisting Moyamoya Disease: Determining the Risk of Ischemic Events Based on Hemodynamic Status Assessment Using Brain Perfusion Single-Photon Emission Computed Tomography.
abstract: OBJECTIVE
  The purposes of this study were to review the cerebrovascular events (CVE) during pregnancy and puerperium in adults with moyamoya disease (MMD) and to evaluate its risk factors.
  
  
  METHODS
  We reviewed electronic medical records on 141 pregnancies in 71 women diagnosed with MMD and this study included only 27 pregnancies (23 patients) diagnosed with MMD before pregnancy. Basal and acetazolamide-stress brain perfusion single-photon emission computed tomography (SPECT) was conducted for 40 hemispheres in 21 pregnancies within 1 year of the gestational period, ranging from 22 months before delivery to 12 months after delivery for evaluation of the hemodynamic status of the patients to devise the MMD treatment strategy.
  
  
  RESULTS
  Twelve pregnancies (44.4%) showed CVE during pregnancy or puerperium in the group diagnosed with MMD before pregnancy. All the 12 CVE were ischemic, without any hemorrhagic events. A decreased cerebral vascular reserve capacity (CVRC) on stress SPECT was observed in 25 (62.5%) of the 40 hemispheres, and 18 of these 25 hemispheres showed TIA. In contrast, only 2 of 15 hemispheres which revealed normal CVRC on stress SPECT showed TIA. Overall, a decreased CVRC on stress SPECT imaging was statistically associated with development of CVE (P < 0.001). Furthermore, the clinical type of MMD was also regarded as predictive factor for CVE in this study. Especially, ischemic type MMD revealed a statistical association with the development of CVE (P = 0.014, odds ratio = 16.50).
  
  
  CONCLUSIONS
  Assessment of cerebral hemodynamic status with stress SPECT may predict CVE during pregnancy and puerperium.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
authors.forename: Si Un
authors.initials: SU
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Boramae Hospital, Seoul, Korea. Electronic address: yschung@snu.ac.kr.
authors.forename: Young Seob
authors.initials: YS
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Bang
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
authors.forename: Gyojun
authors.initials: G
authors.lastname: Hwang
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
authors.forename: Tackeun
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
authors.forename: Seong Yeol
authors.initials: SY
authors.lastname: Ahn
mesh_terms: D000328:Adult; D015984:Causality; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D055420:Perfusion Imaging / Q000706:statistics & numerical data; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cerebral vascular reserve capacity; Cerebrovascular events; Moyamoya disease; Pregnancy; Puerperium