Hemodynamic Reserve and High-Intensity Transient Signals in Moyamoya DiseaseHorn P.a · Lanczik O.b · Vajkoczy P.a · Daffertshofer M.b · Bueltmann E.c · Werner A.d · Schmiedek P.a · Hennerici M.G.b
Departments of aNeurosurgery, bNeurology, cNeuroradiology, and dRadiology, University of Heidelberg, Universitätsklinikum Mannheim, Mannheim, Germany
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: Moyamoya disease (MMD) as a rare obstructive cerebrovascular disease is assumed to present with ischemic symptoms due to hemodynamic compromise. However, alternative mechanisms, such as cerebral embolism in low-flow territories, may also contribute to clinical symptoms. The incidence of high-intensity transient signals (HITS) and the degree of hemodynamic compromise were studied in symptomatic patients with MMD. Methods: Twenty-four patients (17 female, 7 male; mean age 33 ± 13 years) with clinical symptoms attributable to cerebral ischemia and the angiographic features of MMD (21 definite form, 3 probable MMD; 22 patients ‘late stage’ MMD, 2 patients ‘early stage’ MMD) in 45 affected hemispheres were enrolled in the present study. Patients underwent parallel estimation of hemodynamic compromise by means of functional blood flow (rCBF) studies using SPECT, PET or xenon-CT and HITS detection by TCD. Results: Hemodynamic compromise was observed in 37/40 (92%) hemispheres studied. During TCD monitoring, HITS were detected in 3 patients (12.5%), with a total frequency of 3 (6.6%) in the 45 hemispheres investigated. All patients with HITS showed hemodynamic compromise in functional rCBF studies. In these patients, HITS were recorded ipsilateral to the symptomatic hemisphere. HITS occurred in late stage MMD patients only once, while both cases with early stage MMD demonstrated multiple HITS. Conclusions: The incidence of HITS in patients with MMD appears to be lower compared to patients with atherosclerotic or atherothrombotic arterial obstructions. In addition, ischemia-related symptoms in ‘late stage’ MMD seem to be caused by hemodynamic compromise in the majority of these patients.
© 2005 S. Karger AG, Basel
Yonekawa Y, Kahn N: Moyamoya disease. Adv Neurol 2003;92:113–118.
- Horn P, Vajkoczy P, Schmiedek P: Spontaneous occlusion of the circle of Willis (moyamoya disease). Diagnosis and therapy (in German). Nervenarzt 2001;72:406–415.
- Koennecke HC, Mast H, Trocio SH Jr, Sacco RL, Ma W, Mohr JP, et al: Frequency and determinants of microembolic signals on transcranial Doppler in unselected patients with acute carotid territory ischemia. A prospective study. Cerebrovasc Dis 1998;8:107–112.
- Lund C, Rygh J, Stensrod B, Sandset PM, Brucher R, Russell D: Cerebral microembolus detection in an unselected acute ischemic stroke population. Cerebrovasc Dis 2000;10:403–408.
- Babikian VL, Hyde C, Pochay V, Winter MR: Clinical correlates of high-intensity transient signals detected on transcranial Doppler sonography in patients with cerebrovascular disease. Stroke 1994;25:1570–1573.
- Orlandi G, Parenti G, Bertolucci A, Murri L: Silent cerebral microembolism in asymptomatic and symptomatic carotid artery stenoses of low and high degree. Eur Neurol 1997;38:39–43.
- Droste DW, Junker K, Hansberg T, Dittrich R, Ritter M, Ringelstein EB: Circulating microemboli in 33 patients with intracranial arterial stenosis. Cerebrovasc Dis 2002;13:26–30.
- Caplan LR, Hennerici M: Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998;55:1475–1482.
- Wong KS, Gao S, Chan YL, Hansberg T, Lam WW, Droste DW, et al: Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: A diffusion-weighted imaging and microemboli monitoring study. Ann Neurol 2002;52:74–81.
- Suzuki J, Takaku A: Cerebrovascular ‘moyamoya’ disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 1969;20:288–299.
- Schmiedek P, Piepgras A, Leinsinger G, Kirsch CM, Einhaeupl K: Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg 1994;81:236–244.
- Spencer MP, Thomas GI, Nicholls SC, Sauvage LR: Detection of middle cerebral artery emboli during carotid endarterectomy using transcranial Doppler ultrasonography. Stroke 1990;21:415–423.
- Mess WH, Willigers JM, Ledoux LA, Ackerstaff RG, Hoeks AP: Microembolic signal description: A reappraisal based on a customized digital postprocessing system. Ultrasound Med Biol 2002;28:1447–1455.
- Hennerici MG, Meairs S: Refined analysis of transcranial Doppler HITS. Lancet Neurol 2002;1:406.
- Markus H, Cullinane M, Reid G: Improved automated detection of embolic signals using a novel frequency filtering approach. Stroke 1999;30:1610–1615.
- Nicolaides A, Sabetai M, Kakkos SK, Dhanjil S, Tegos T, Stevens JM, et al: The Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study: Aims and results of quality control. Int Angiol 2003;22:263–272.
- Kuwabara Y, Ichiya Y, Sasaki M, Yoshida T, Masuda K, Ikezaki K, et al: Cerebral hemodynamics and metabolism in moyamoya disease – A positron emission tomography study. Clin Neurol Neurosurg 1997;99(suppl 2):74–78.
- Taki W, Yonekawa Y, Kobayashi A, Ishikawa M, Kikuchi H, Nishizawa S, et al: Cerebral circulation and metabolism in adults’ moyamoya disease – PET study. Acta Neurochir (Wien) 1989;100:150–154.
- Nariai T, Senda M, Ishii K, Wakabayashi S, Yokota T, Toyama H, et al: Posthyperventilatory steal response in chronic cerebral hemodynamic stress: A positron emission tomography study. Stroke 1998;29:1281–1292.
- Daffertshofer M, Ries S, Schminke U, Hennerici M: High-intensity transient signals in patients with cerebral ischemia. Stroke 1996;27:1844–1849.
- Ries S, Schminke U, Daffertshofer M, Hennerici M: High intensity transient signals (HITS) in patients with carotid artery disease. Eur J Med Res 1996;1:328–330.
Russell D: Cerebral microemboli and cognitive impairment. J Neurol Sci 2002;203–204:211–214.
- Junghans U, Siebler M: Cerebral microembolism is blocked by tirofiban, a selective nonpeptide platelet glycoprotein IIb/IIIa receptor antagonist. Circulation 2003;107:2717–2721.
- Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, et al: A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001;345:1444–1451.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.