Limits...
Moyamoya disease manifested as multiple simultaneous intracerebral hemorrhages: A case report and literature review

View Article: PubMed Central - PubMed

ABSTRACT

Multiple simultaneous intracerebral hemorrhages (MSIH) caused by Moyamoya disease (MMD) is extremely rare. To date, the clinical manifestations, imaging characteristics and mechanism of MMD-induced MSIH have not yet been elucidated. In order to improve the understanding on such cases, the present study described a rare case of MSIH caused by MMD. A 40-year-old female patient with no history of hypertension or diabetes mellitus experienced a sudden headache followed by coma. Cranial computed tomography (CT) examination revealed MSIH in the left frontal area, temporal lobe and basal ganglia. CT angiography and digital subtraction angiography examinations revealed typical characteristics of MMD. Subsequent to excluding disorders of the blood system and blood coagulation, we concluded that the present case of MSIH was caused by MMD. Hematoma evacuation and decompressive craniectomy were performed with satisfactory results. In addition, after reviewing previous MSIH cases in the literature, potential mechanisms of MMD-mediated MSIH were considered. In conclusion, MMD should be considered as a possible cause of MSIH during diagnosis and treatment. MMD can lead to pathological changes in the fragility of small arteries; therefore, rupture and hemorrhage at one site may induce a transient increase in blood pressure, causing the rupture of small arteries at other sites, and thus leading to MSIH. Hematoma evacuation and decompression should be conducted in selective cases of MMD-induced MSIH in order to achieve a good prognosis.

No MeSH data available.


Related in: MedlinePlus

Preoperative cranial computed tomography scans showing multiple intracranial hemorrhages in sections of the (A and B) basal ganglia, (C and D) lateral ventricle body and (E and F) lateral ventricle loop. Irregular high density zones in the basal ganglia, posterior temporal lobe and frontal lobe, with mild peripheral edema. The left ventricle showed deformation under compression, with the midline shifted to the right.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4997912&req=5

f1-etm-0-0-3477: Preoperative cranial computed tomography scans showing multiple intracranial hemorrhages in sections of the (A and B) basal ganglia, (C and D) lateral ventricle body and (E and F) lateral ventricle loop. Irregular high density zones in the basal ganglia, posterior temporal lobe and frontal lobe, with mild peripheral edema. The left ventricle showed deformation under compression, with the midline shifted to the right.

Mentions: Written informed consent was obtained from the patient. A 40-year-old female patient with no history of hypertension and diabetes mellitus was admitted the First Hospital of Jilin University (Changchun, China) in June 2015 due to presentation of sudden severe headache and vomiting followed by gradual coma for 2 h. Physical examinations revealed stable vital signs with a blood pressure of 140/90 mmHg, and the neurological examination showed minor coma (Glasgow Coma Scale score, 11) (8), right hemiplegia, degree 3 muscle strength, positive Babinski sign, and stiffness in the neck with Kernig's sign (9). Laboratory tests indicated normal blood coagulation and platelet counts. Cranial computed tomography (CT) revealed multiple irregular high density zones in the left basal ganglia, posterior temporal lobe and frontal lobe, with mild peripheral edema. The left ventricle showed deformation under compression, with the midline shifted to the right (Fig. 1). Cranial CT angiography (CTA) subsequent to admission demonstrated that the normal vascular morphology in the area of the bilateral middle cerebral artery was disrupted, with visible hematomas in the maximum intensity projection axis (Fig. 2). Based on the symptoms and the radiographic examination findings, a clear diagnosis of MMD and intracerebral MSIH was established.


Moyamoya disease manifested as multiple simultaneous intracerebral hemorrhages: A case report and literature review
Preoperative cranial computed tomography scans showing multiple intracranial hemorrhages in sections of the (A and B) basal ganglia, (C and D) lateral ventricle body and (E and F) lateral ventricle loop. Irregular high density zones in the basal ganglia, posterior temporal lobe and frontal lobe, with mild peripheral edema. The left ventricle showed deformation under compression, with the midline shifted to the right.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4997912&req=5

f1-etm-0-0-3477: Preoperative cranial computed tomography scans showing multiple intracranial hemorrhages in sections of the (A and B) basal ganglia, (C and D) lateral ventricle body and (E and F) lateral ventricle loop. Irregular high density zones in the basal ganglia, posterior temporal lobe and frontal lobe, with mild peripheral edema. The left ventricle showed deformation under compression, with the midline shifted to the right.
Mentions: Written informed consent was obtained from the patient. A 40-year-old female patient with no history of hypertension and diabetes mellitus was admitted the First Hospital of Jilin University (Changchun, China) in June 2015 due to presentation of sudden severe headache and vomiting followed by gradual coma for 2 h. Physical examinations revealed stable vital signs with a blood pressure of 140/90 mmHg, and the neurological examination showed minor coma (Glasgow Coma Scale score, 11) (8), right hemiplegia, degree 3 muscle strength, positive Babinski sign, and stiffness in the neck with Kernig's sign (9). Laboratory tests indicated normal blood coagulation and platelet counts. Cranial computed tomography (CT) revealed multiple irregular high density zones in the left basal ganglia, posterior temporal lobe and frontal lobe, with mild peripheral edema. The left ventricle showed deformation under compression, with the midline shifted to the right (Fig. 1). Cranial CT angiography (CTA) subsequent to admission demonstrated that the normal vascular morphology in the area of the bilateral middle cerebral artery was disrupted, with visible hematomas in the maximum intensity projection axis (Fig. 2). Based on the symptoms and the radiographic examination findings, a clear diagnosis of MMD and intracerebral MSIH was established.

View Article: PubMed Central - PubMed

ABSTRACT

Multiple simultaneous intracerebral hemorrhages (MSIH) caused by Moyamoya disease (MMD) is extremely rare. To date, the clinical manifestations, imaging characteristics and mechanism of MMD-induced MSIH have not yet been elucidated. In order to improve the understanding on such cases, the present study described a rare case of MSIH caused by MMD. A 40-year-old female patient with no history of hypertension or diabetes mellitus experienced a sudden headache followed by coma. Cranial computed tomography (CT) examination revealed MSIH in the left frontal area, temporal lobe and basal ganglia. CT angiography and digital subtraction angiography examinations revealed typical characteristics of MMD. Subsequent to excluding disorders of the blood system and blood coagulation, we concluded that the present case of MSIH was caused by MMD. Hematoma evacuation and decompressive craniectomy were performed with satisfactory results. In addition, after reviewing previous MSIH cases in the literature, potential mechanisms of MMD-mediated MSIH were considered. In conclusion, MMD should be considered as a possible cause of MSIH during diagnosis and treatment. MMD can lead to pathological changes in the fragility of small arteries; therefore, rupture and hemorrhage at one site may induce a transient increase in blood pressure, causing the rupture of small arteries at other sites, and thus leading to MSIH. Hematoma evacuation and decompression should be conducted in selective cases of MMD-induced MSIH in order to achieve a good prognosis.

No MeSH data available.


Related in: MedlinePlus