Clinical And Imaging Characteristics Of Adult Moyamoya Disease

Objective Because the clinical manifestations of Moyamoya disease MMD are various and non specific,it is often easy to misdiagnose and misdiagnose.In this study,the clinical and imaging features of adult MMD patients were analyzed retrospectively,so that clinicians could further understand MMD,prevent misdiagnosis and provide a reasonable treatment for clinical work.Methods The clinical manifestations and imaging features of 91 adult MMD patients hospitalized in The 105 th Hospital of PLA from January 2012 to January 2017 were retrospectively analyzed.Results(1)The study included 91 cases of adult moyamoya disease,34 men(37.36%)and 57 women(62.64%).A total of 91 cases aged 20 to 79 years(mean 48.15±10.69 years old).The main clinical manifestations were two cases of Hemorrhagic stroke and Ischemic stroke.In this study,hemorrhagic stroke patients were the main(82 cases,90.11%).The first symptoms of MMD in hemorrhagic group were disturbance of consciousness(54.95%),headache(54.95%),limb weakness(19.78%),dizziness(15.38%),and speech disorder(8.79%).The first symptoms of MMD in ischemic group were limb weakness(4.40%),dizziness(2.20%),headache(2.20%),speech disorder(2.20%),and disturbance of consciousness(1.10%).11% of the total patients in this study were unilateral MMD.The female was more than male.The ratio of male to female was 1: 1.5,and the cerebral hemorrhage as the main type.Compared with typical MMD,the clinical manifestation of unilateral MMD was not significantly different.(2)In this study,91 patients were given Head CT and MRI: 82 cases of cerebral hemorrhage,6 cases of cerebral infarction,2 cases of ischemic andhemorrhagic mixed type,and 1 case of no abnormality.The common parts of cerebral hemorrhage are: 29 cases of basal ganglia,23 cases of ventricles of the brain,15 cases of lobar,8 cases of subarachnoid space,6 cases of thalamus,1 case of internal capsule.In hemorrhagic moyamoya disease,the ratio of male to female was 1:1.83,and the female was more than the male.Both male and female patients were mainly cerebral hemorrhage,intraventricular hemorrhage and subarachnoid hemorrhage.The cerebral parenchyma hemorrhage(36 women,15 men),ventricular hemorrhage(12 women,11 men),and 8 subarachnoid hemorrhage.(3)The vascular examination of 91 cases of MMD patients was as follows: 79 cases of CTA,6 cases of MRA and 19 cases of DSA.There was no significant difference between CTA and DSA examination in detecting ICA,ACA,MCA or PCA stenosis or occlusion,both of them could clearly show the vascular network of abnormal hyperplasia of the skull base.Of the 91 patients,there were 17 cases of aneurysm(12 women,5 men),4 cases of combined arteriovenous malformation,2 cases of men and 2 cases of women.Conclusion 1)The peak of adult moyamoya disease may be 41-50 years old,and the female was more than male,The proportion of consciousness disorder and headache dizziness in the hemorrhagic group was significantly higher than that in the ischemic group.Unilateral moyamoya disease accounted for 11% of the total number of moyamoya disease.The results showed that unilateral MMD patients were mainly female,and the ratio of male to female was 1: 1.5,and the cerebral hemorrhage as the main type.2)CTA may be a rapid and effective method for screening and early diagnosis of moyamoya disease.Cerebral aneurysms or arteriovenous malformations may be the cause of intracerebral hemorrhage in adult moyamoya disease.