| Moyamoya disease is characterized by a progressive stenosis of the terminal portion of internal carotid arteries and the development of a network of abnormal collateral vessels.It occurs worldwide,38.4% is children. Most children with Moyamoya disease develop transient ischemic attack or cerebral infarction. On the other hand, headache is one of the major complaints in pediatric patients with Moyamoya disease, even the only one symptom in some children. However, there are few study about the headache in children with Moyamoya disease. The clinical feature and effect of surgery is unclear. Through retrospection of the clinical data of the children with Moyamoya disease in our department, the study aims to discuss the questions above.Objective Through retrospection of the clinical data of headache in pediatric with Moyamoya disease. The study aims to clarify the onset time, location, triggers, severity of headache in children, analyze the relationship between the age, gender, the number of affected vessels, Suzuki‘ stage, severity of headache and effect of surgery, discuss factor-relating of the clinical data, the effect of operation.Methods Retrospectively analyze the data of patients who had MMD and admitted to our department from Jan 2004 to Dec 2013.According to the case inclusion criteria and exclusion criteria, a total of 103 pediatric patients were included in our study. The following characteristics were recorded: age, gender, the number of affected vessels, Suzuki‘ stage, severity of headache. Through phone or clinical follow-up, we know the headache relief or disappearance in pediatric with Moyamoya disease. According to the impact of headache on daily life, the headache was divided into 4 levels. According to the degree of headache improvement and whether with other neurologic deficits, headache clinical prognosis was divided into 3 groups. According to the growth rang size of temporal artery in the middle carotid artery supply zone, vessel growth was divided into 3 levels. The age, the number of affected vessels, Suzuki‘ stage, severity of headache are processed by rank sum test. The gender and whether or no accompanying symptoms are processed by chi-square test. All the data are analyzed by SPSS20.0 software.Results 1. A total of 512 cases of patients were treated in our department between Jan 2004 to Dec 2013.There are 103 pediatric patients meet the conditions of enrollment,of which 53 cases of male(51.5%),female 50 cases(48.5%),male to female ratio was 1.06:1.The gender composition was no obvious difference,men slightly more than women.Age range from 1.5 years to 17 years,mean age was 9.1±3.8 years. 2. Headache was observed in 103 patients before surgery,in which 71 patients had headache as the first symptom(16 patients had headahce alone),and 87(84.5%) accompanied by other symptoms.The frequency of headache:a few times every day in 4 patients(3.9%),a few times per week in 20 patents(19.4%),a few times per month in 57 patients(55.3%),a few times per years in 22 patients(21.4%). Headache developed in the morning in 11 patients(10.7%),in the night in 2 patients(1.9%).Headache developed in 22 patients(21.4%) when the day is cold or the patients is emotinal,tired.The timing of headache could not be defined in another patients(66%).Severity of headache was graded as severe in 30 patients(29.1%),whose headache influenced the daily life and accompanied by nausea and vomiting.Persistent headache was observed in 2 patients, but the headache was small influence on daily life. Headache could be localized in bilateral frontal area in 49 patients(47.6%),the frontal area in 6(5.8%),the bilateral temporal area in 21(20.4%),the temporal area in 4(3.9%) and other head area. Most of them complained bursting pain, stabbing pain and dull pain. Most of the headache spontaneously resolved from several hours to 72 hours. 3. EDAS was performed on 192 hemispheres of 103 patients. Headache resolved in 2 weeks to 3 months after surgery. No TIA was occurred during the follow-up period after surgery. Postoperative angiography showed large compensatory supply of vessels from temporal shallow artery to intracranial. The vessel growth situations of all patients are excellent on angiography. The mean follow-up period was 85.3 ± 45.7months,range from 6 to 144 months.During the follow-up period,headache of 86 pediatric patients disappeared,clinical prognosis is excellence(unilateral headache disappeared in 14 patients after surgery in headache side,in 2 of whom had contralateral headache,headache disappeared after surgery in the headache side).The headache relieved in 17 patients,clinical prognosis is good(16.5%). 4. Resulits of statically analysis. According to remission condition of headache, the patients were divided into disappearance group and remission group, The age, the number of affected vessels, Suzuki‘ stage, severity of headache, gender and accompanying symptoms between the two group were performing statistical analysis, none of them had statistical significance. The patients whose headache was the first symptom are divided into headache alone group and headache with other symptoms group, the two group is processed by rank sum test and had statistical significance, P<0.05.Conclusion 1. Most of the headache in pediatric with Moyamoya disease was localized in frontal, temporal area. Most of the patients complained bursting pain, stabbing pain and dull pain. There were no aura symptoms before headache. Some of the patients had Headache when the day is cold or the patients is emotinal,tired.Some pediatric patients had severe headache accompanied by nausea and vomiting,even had transient limb weakness and aphasia. And the headahce influenced the daily life,a few of patients needed painkiller to relief the headache. 2. We think that headache is one of the early symptoms in pediatric patients with Moyamoya disease, and the early signal of cerebral ischemia etc. symptoms in some pediatric patients with Moyamoya disease. 3. EDAS can increase intracranial blood supply, improve the condition of cerebral ischemic and relief the headache in pediatric patients with Moyamoya disease. |
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