Intracerebral hemorrhage and ischaemic stroke due to Moyamoya disease in young patients: a case report

Ricky Dany Agus Wicaksono; Achmad Firdaus Sani; Dedy Kurniawan

doi:10.15562/bmj.v12i3.4667

Intracerebral hemorrhage and ischaemic stroke due to Moyamoya disease in young patients: a case report

Ricky Dany Agus Wicaksono ,

Achmad Firdaus Sani ,

Dedy Kurniawan ,

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DOI: https://doi.org/10.15562/bmj.v12i3.4667 |
Published: 2023-08-09

Abstract

Link of Video Abstract: https://youtu.be/DWVi34rPNOg

Background: Moyamoya disease (MMD) is a non-atherosclerotic cerebrovascular disorder characterized by progressive stenosis of the distal part of the internal carotid artery (ICA), thus forming an abnormal vascular network in the base of the brain. MMD is often found in women. The common symptoms of MMD are migraine, epilepsy, recurrent transient ischemic attack (TIA), ischemic stroke, and intracerebral hemorrhage. Stroke at young onset has challenges in looking for risk factors and etiology. A detailed examination is needed to prevent recurrent strokes.

Case Presentation: Male 17-year-old complained of a throbbing headache on the right side for 5 months, with a numeric rating scale (NRS) 4. The headache duration was 24-72 hours, with a frequency of 1-2 times a month. Complaints are exacerbated by activity and improve when taking over medication. 2 months after the first onset, he felt severe headache with NRS 7, accompanied by weakness and tingling on the left side. All his laboratory results were within normal limits. Cerebral Digital Subtraction Angiography (DSA) results showed severe stenosis at the base of the right ICA bifurcation segment accompanied by slow flow at the right middle cerebral artery (MCA) and severe stenosis at the base of the left ICA accompanied by cross-filling to the contralateral anterior cerebral artery (ACA). Cortico-cortical collaterals were obtained from the posterior cerebral artery (PCA) branch covering the MCA area. The patient was diagnosed with MMD.

Conclusion: MMD is a rare cerebrovascular disease that can be a risk factor for stroke at a young age. Diagnosis and evaluation of the collateral system need to be carried out through cerebral angiography so that the selection and consideration of appropriate management of recurrent stroke attacks can be carried out.

References

Fujimura M, Bang OY, Kim JS. Moyamoya Disease. Front Neurol Neurosci. 2016;40(1):204–220.
Shang S, Zhou D, Ya J, Li S, Yang Q, Ding Y, et al. Progress in moyamoya disease. Neurosurg Rev. 2020;43(2):371–82.
Canavero I, Vetrano IG, Zedde M, Pascarella R, Gatti L, Acerbi F, et al. Clinical Management of Moyamoya Patients. 2021;10(16):1–20.
Burke GM, Burke AM, Sherma AK, Hurley MC, Batjer HH, Bendok BR. Moyamoya disease: a summary. Neurosurgical focus. 2009;26(4):E11.
Funaki T, Takahashi JC, Houkin K, Kuroda S, Takeuchi S, Fujimura M, et al. Angiographic features of hemorrhagic moyamoya disease with high recurrence risk: A supplementary analysis of the Japan Adult Moyamoya Trial. J Neurosurg. 2018;128(3):777–784.
Janda PH, Bellew JG, Veerappan V. Moyamoya Disease: Case Report and Literature Review. J Am Osteopath Assoc. 2009;109(10):547–553.
Hishikawa T, Sugiu K, Date I. Moyamoya disease: A review of clinical research. Acta Med Okayama. 2016;70(4):229–236.
Baltsavias G, Khan N, Valavanis A. The collateral circulation in pediatric moyamoya disease. Child’s Nerv Syst. 2015;31(3):389–398.
Kang S, Liu X, Zhang D, Wang R, Zhang Y, Zhang Q, et al. Natural Course of Moyamoya Disease in Patients With Prior Hemorrhagic Stroke: Clinical Outcome and Risk Factors. Stroke. 2019;50(5):1060–1066.
Fujimura M, Tominaga T. Hemorrhagic Moyamoya Disease : A Recent Update. J Korean Neurosurg Soc. 2019;62(2):136–143.
Golden N, Mardhika PE, Niryana W, Sukarya IM, Prabawa IPY. Risk factors and novel prognostic score for predicting the 14-day mortality of severe traumatic brain injury patients. Intisari Sains Medis. 2020;11(3):1020-1028.
Sasmita PK, Setyopranoto I, Wibowo S, Sadewa AH. Correlation between serum S100Î² protein level with neurological deficit in patients with acute intracerebral hemorrhage. Bali Medical Journal. 2018;8(1):63–68.
Tini K, Samatra IDPGP, Wiryadana KA, Supadmanaba IGP. Clinical profile of patients with cerebrovascular disease at Stroke Unit, Sanglah General Hospital, Denpasar, Bali. Bali Medical Journal. 2020;9(1):129–136.
Nabilah, Wibisono S, Libriansyah, Wahyuhadi J, Arifianto MR. Diagnostic problems and management of pituitary gigantism leading to ischemic stroke and atrial myxoma in young adult patient: a case report. Bali Medical Journal. 2022;11(1):238–240.
Zhang A, Brown N, Cheaney B, Campos JK, Chase Ransom R, Hsu FPK. Updates in the management of moyamoya disease. Interdiscip Neurosurg Adv Tech Case Manag. 2021;23(2020):100976.
Zipfel GJ, Fox DJ, Rivet DJ. Moyamoya disease in adults: The role of cerebral revascularization. Skull Base. 2005;15(1):27–41.

[1] Fujimura M, Bang OY, Kim JS. Moyamoya Disease. Front Neurol Neurosci. 2016;40(1):204–220.

[2] Shang S, Zhou D, Ya J, Li S, Yang Q, Ding Y, et al. Progress in moyamoya disease. Neurosurg Rev. 2020;43(2):371–82.

[3] Canavero I, Vetrano IG, Zedde M, Pascarella R, Gatti L, Acerbi F, et al. Clinical Management of Moyamoya Patients. 2021;10(16):1–20.

[4] Burke GM, Burke AM, Sherma AK, Hurley MC, Batjer HH, Bendok BR. Moyamoya disease: a summary. Neurosurgical focus. 2009;26(4):E11.

[5] Funaki T, Takahashi JC, Houkin K, Kuroda S, Takeuchi S, Fujimura M, et al. Angiographic features of hemorrhagic moyamoya disease with high recurrence risk: A supplementary analysis of the Japan Adult Moyamoya Trial. J Neurosurg. 2018;128(3):777–784.

[6] Janda PH, Bellew JG, Veerappan V. Moyamoya Disease: Case Report and Literature Review. J Am Osteopath Assoc. 2009;109(10):547–553.

[7] Hishikawa T, Sugiu K, Date I. Moyamoya disease: A review of clinical research. Acta Med Okayama. 2016;70(4):229–236.

[8] Baltsavias G, Khan N, Valavanis A. The collateral circulation in pediatric moyamoya disease. Child’s Nerv Syst. 2015;31(3):389–398.

[9] Kang S, Liu X, Zhang D, Wang R, Zhang Y, Zhang Q, et al. Natural Course of Moyamoya Disease in Patients With Prior Hemorrhagic Stroke: Clinical Outcome and Risk Factors. Stroke. 2019;50(5):1060–1066.

[10] Fujimura M, Tominaga T. Hemorrhagic Moyamoya Disease : A Recent Update. J Korean Neurosurg Soc. 2019;62(2):136–143.

[11] Golden N, Mardhika PE, Niryana W, Sukarya IM, Prabawa IPY. Risk factors and novel prognostic score for predicting the 14-day mortality of severe traumatic brain injury patients. Intisari Sains Medis. 2020;11(3):1020-1028.

[12] Sasmita PK, Setyopranoto I, Wibowo S, Sadewa AH. Correlation between serum S100Î² protein level with neurological deficit in patients with acute intracerebral hemorrhage. Bali Medical Journal. 2018;8(1):63–68.

[13] Tini K, Samatra IDPGP, Wiryadana KA, Supadmanaba IGP. Clinical profile of patients with cerebrovascular disease at Stroke Unit, Sanglah General Hospital, Denpasar, Bali. Bali Medical Journal. 2020;9(1):129–136.

[14] Nabilah, Wibisono S, Libriansyah, Wahyuhadi J, Arifianto MR. Diagnostic problems and management of pituitary gigantism leading to ischemic stroke and atrial myxoma in young adult patient: a case report. Bali Medical Journal. 2022;11(1):238–240.

[15] Zhang A, Brown N, Cheaney B, Campos JK, Chase Ransom R, Hsu FPK. Updates in the management of moyamoya disease. Interdiscip Neurosurg Adv Tech Case Manag. 2021;23(2020):100976.

[16] Zipfel GJ, Fox DJ, Rivet DJ. Moyamoya disease in adults: The role of cerebral revascularization. Skull Base. 2005;15(1):27–41.

Intracerebral hemorrhage and ischaemic stroke due to Moyamoya disease in young patients: a case report

Abstract

References

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