title: [Emergency Bypass Surgery for Progressive Cerebral Infarction Following Hemorrhagic Onset of Moyamoya Disease:A Case Report].
abstract: Progressive cerebral infarction in patients with hemorrhagic onset of moyamoya disease is rare, and a treatment strategy is not well established. Here, we report a case that was successfully treated with emergency bypass surgery. A 58-year-old woman presented with a sudden disturbance of consciousness and right-sided hemiparesis. Computed tomography(CT)showed intraventricular hemorrhage involving the head of the left caudate nucleus. Ventricular drainage was immediately performed, and the patient was treated conservatively. Magnetic resonance(MR)angiography revealed bilateral stenosis of the supraclinoid internal carotid artery(ICA), and arterial spin labeling(ASL)showed low signal intensity in the left cerebral hemisphere. The patient was diagnosed with hemorrhagic onset of moyamoya disease with cerebral infarction. Her neurological symptoms worsened on the 7th day after ictus despite medical treatment. MR imaging showed a new infarction in the left insular cortex. Based on the diagnosis of progressive stroke, emergency anastomoses between the superficial temporal artery and the middle and anterior cerebral arteries, along with encephalo-duro-myo-synangiosis, were performed. Her symptoms gradually improved following surgery, and 1 month later, she was able to regain independent function. Emergency bypass surgery may be the treatment of choice for patients with hemorrhagic onset of moyamoya disease presenting with progressive cerebral infarction, despite conservative treatments.
authors.affiliation: Department of Neurosurgery, Akita University Graduate School of Medicine.
authors.forename: Junya
authors.initials: J
authors.lastname: Hatakeyama
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: Erina
authors.initials: E
authors.lastname: Kudo
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Togashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
mesh_terms: D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002544:Cerebral Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D064847:Multimodal Imaging; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures