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The rare association of moyamoya disease and cerebral arteriovenous malformations: a case report.

Wu TC, Guo WY, Wu HM, Chang FC, Shiau CY, Chung WY - Korean J Radiol (2008)

Bottom Line: A 36-year-old man was diagnosed with a right temporal lobe grade II cerebral arteriovenous malformation (cAVM) and was treated with radiosurgery.The narrowing progressively deteriorated as was demonstrated on longitudinal serial follow-up MR imaging.Given the chronological sequence of disease development and radiation dose distribution of radiosurgery, it is proposed that humoral or unknown predisposing factors, rather than direct radiation effects, are the cause of moyamoya disease associated with cAVM.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chi-Mei Foundation Hospital, Tainan, Taiwan.

ABSTRACT
A 36-year-old man was diagnosed with a right temporal lobe grade II cerebral arteriovenous malformation (cAVM) and was treated with radiosurgery. At nine months after the cAVM radiosurgery, the patient began to develop bilateral focal narrowing at the M1 segments of the bilateral middle cerebral arteries. The narrowing progressively deteriorated as was demonstrated on longitudinal serial follow-up MR imaging. X-ray angiography performed at 51 months after radiosurgery confirmed that the cAVM was cured and a diagnosis of moyamoya disease. To the best of our knowledge, this is the first case of cAVM-associated moyamoya disease that developed after radiosurgery. Given the chronological sequence of disease development and radiation dose distribution of radiosurgery, it is proposed that humoral or unknown predisposing factors, rather than direct radiation effects, are the cause of moyamoya disease associated with cAVM.

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Moyamoya disease and concurrent cerebral arteriovenous malformation in 36-year-man.A. Composite anteroposterior (AP) view of bilateral carotid angiogram shows right temporal cerebral rteriovenous malformation.B, C. Stereotactic MRI with dose plan show that 17.5 Gy (yellow isodose line) is prescribed to perihphery of cerebral arteriovenous malformation nidus (magenta line). Supraclinoid segment of right internal carotid arteries and proximal middle cerebral artery received dose of 6.25 Gy (green isodose line).D, E. Nine months (D) and 34 months (E) after gamma-knife surgery. Time-of-light (TOF) MR angiograms show progressive focal stenosis at bilateral middle cerebral artery.F. At 51 months after gamma-knife radiosurgery, bilateral carotid angiogram confirms cure of cerebral arteriovenous malformation and occlusion of bilateral supraclinoid internal carotid arteries, proximal middle cerebral artery and anterior cerebral artery with moyamoya collateral vessels.
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Figure 1: Moyamoya disease and concurrent cerebral arteriovenous malformation in 36-year-man.A. Composite anteroposterior (AP) view of bilateral carotid angiogram shows right temporal cerebral rteriovenous malformation.B, C. Stereotactic MRI with dose plan show that 17.5 Gy (yellow isodose line) is prescribed to perihphery of cerebral arteriovenous malformation nidus (magenta line). Supraclinoid segment of right internal carotid arteries and proximal middle cerebral artery received dose of 6.25 Gy (green isodose line).D, E. Nine months (D) and 34 months (E) after gamma-knife surgery. Time-of-light (TOF) MR angiograms show progressive focal stenosis at bilateral middle cerebral artery.F. At 51 months after gamma-knife radiosurgery, bilateral carotid angiogram confirms cure of cerebral arteriovenous malformation and occlusion of bilateral supraclinoid internal carotid arteries, proximal middle cerebral artery and anterior cerebral artery with moyamoya collateral vessels.

Mentions: A 36-year-old man suffered from intermittent episodes of dizziness and complex visual hallucinations for 2-3 years of irregular duration and interval. Due to a newly developed numbness sensation over the right temporal region for one month, the patient arrived at our hospital and asked for assistance. No loss of consciousness was found for each attack and the patient was neurologically intact. The cerebral angiography (Fig. 1A) showed a Spetzler grade II cAVM located at the right anterior temporal lobe that received an arterial supply mainly from the anterior temporal branches of the right middle cerebral artery (MCA) and the right posterior cerebral artery (PCA) and showed early draining mainly into the right superficial middle cerebral vein. No focal stenosis of the intracrainal vessels was found at the initial presentation. The patient underwent GKRS with a maximum target dose of 31.25 Gy and a minimum dose of 17.5 Gy to the periphery of the cAVM nidus at a 56% isodose level of the maximum target dose (average dose of 23.6 Gy). The cAVM nidus volume was estimated as 20.7 ml. The supraclinoid segment of the right internal carotid artery and proximal MCA and anterior cerebral artery (ACA) received as dose less than 6.25 Gy (20% isodose level) (Figs. 1B, C). The arteries on the contra-lateral side received far less than this radiation dose.


The rare association of moyamoya disease and cerebral arteriovenous malformations: a case report.

Wu TC, Guo WY, Wu HM, Chang FC, Shiau CY, Chung WY - Korean J Radiol (2008)

Moyamoya disease and concurrent cerebral arteriovenous malformation in 36-year-man.A. Composite anteroposterior (AP) view of bilateral carotid angiogram shows right temporal cerebral rteriovenous malformation.B, C. Stereotactic MRI with dose plan show that 17.5 Gy (yellow isodose line) is prescribed to perihphery of cerebral arteriovenous malformation nidus (magenta line). Supraclinoid segment of right internal carotid arteries and proximal middle cerebral artery received dose of 6.25 Gy (green isodose line).D, E. Nine months (D) and 34 months (E) after gamma-knife surgery. Time-of-light (TOF) MR angiograms show progressive focal stenosis at bilateral middle cerebral artery.F. At 51 months after gamma-knife radiosurgery, bilateral carotid angiogram confirms cure of cerebral arteriovenous malformation and occlusion of bilateral supraclinoid internal carotid arteries, proximal middle cerebral artery and anterior cerebral artery with moyamoya collateral vessels.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627196&req=5

Figure 1: Moyamoya disease and concurrent cerebral arteriovenous malformation in 36-year-man.A. Composite anteroposterior (AP) view of bilateral carotid angiogram shows right temporal cerebral rteriovenous malformation.B, C. Stereotactic MRI with dose plan show that 17.5 Gy (yellow isodose line) is prescribed to perihphery of cerebral arteriovenous malformation nidus (magenta line). Supraclinoid segment of right internal carotid arteries and proximal middle cerebral artery received dose of 6.25 Gy (green isodose line).D, E. Nine months (D) and 34 months (E) after gamma-knife surgery. Time-of-light (TOF) MR angiograms show progressive focal stenosis at bilateral middle cerebral artery.F. At 51 months after gamma-knife radiosurgery, bilateral carotid angiogram confirms cure of cerebral arteriovenous malformation and occlusion of bilateral supraclinoid internal carotid arteries, proximal middle cerebral artery and anterior cerebral artery with moyamoya collateral vessels.
Mentions: A 36-year-old man suffered from intermittent episodes of dizziness and complex visual hallucinations for 2-3 years of irregular duration and interval. Due to a newly developed numbness sensation over the right temporal region for one month, the patient arrived at our hospital and asked for assistance. No loss of consciousness was found for each attack and the patient was neurologically intact. The cerebral angiography (Fig. 1A) showed a Spetzler grade II cAVM located at the right anterior temporal lobe that received an arterial supply mainly from the anterior temporal branches of the right middle cerebral artery (MCA) and the right posterior cerebral artery (PCA) and showed early draining mainly into the right superficial middle cerebral vein. No focal stenosis of the intracrainal vessels was found at the initial presentation. The patient underwent GKRS with a maximum target dose of 31.25 Gy and a minimum dose of 17.5 Gy to the periphery of the cAVM nidus at a 56% isodose level of the maximum target dose (average dose of 23.6 Gy). The cAVM nidus volume was estimated as 20.7 ml. The supraclinoid segment of the right internal carotid artery and proximal MCA and anterior cerebral artery (ACA) received as dose less than 6.25 Gy (20% isodose level) (Figs. 1B, C). The arteries on the contra-lateral side received far less than this radiation dose.

Bottom Line: A 36-year-old man was diagnosed with a right temporal lobe grade II cerebral arteriovenous malformation (cAVM) and was treated with radiosurgery.The narrowing progressively deteriorated as was demonstrated on longitudinal serial follow-up MR imaging.Given the chronological sequence of disease development and radiation dose distribution of radiosurgery, it is proposed that humoral or unknown predisposing factors, rather than direct radiation effects, are the cause of moyamoya disease associated with cAVM.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chi-Mei Foundation Hospital, Tainan, Taiwan.

ABSTRACT
A 36-year-old man was diagnosed with a right temporal lobe grade II cerebral arteriovenous malformation (cAVM) and was treated with radiosurgery. At nine months after the cAVM radiosurgery, the patient began to develop bilateral focal narrowing at the M1 segments of the bilateral middle cerebral arteries. The narrowing progressively deteriorated as was demonstrated on longitudinal serial follow-up MR imaging. X-ray angiography performed at 51 months after radiosurgery confirmed that the cAVM was cured and a diagnosis of moyamoya disease. To the best of our knowledge, this is the first case of cAVM-associated moyamoya disease that developed after radiosurgery. Given the chronological sequence of disease development and radiation dose distribution of radiosurgery, it is proposed that humoral or unknown predisposing factors, rather than direct radiation effects, are the cause of moyamoya disease associated with cAVM.

Show MeSH
Related in: MedlinePlus