The Characteristics Of Moyamoya Disease Around Poyang Lake And The Risk Factors Of Cerebral Hyperperfusion Syndrome After Combined Revascularization Surgery

Objective:1.To analyze the morbidity of cocoyam disease in the area around Loyang Lake.2.To investigate the clinical manifestations and risk factors of cerebral hyperinflation syndrome after undergoing combined superficial temporal artery-middle cerebral artery(STA-CA)anatomist and cephalic-Duroc-Wyo-angina-Isis(EDMS)of cocoyam disease?Methods:1.A total of 275 cases of cocoyam disease were admitted to the Department of Neurosurgery,Second Affiliated Hospital of Nanchang University from June 2017 to December 2018.The data of age,sex,first symptoms,imaging examination and address were collected and analyzed.At the same time,according to the first symptoms and imaging examination,the patients were divided into cerebral alchemist group,cerebral hemorrhage group,asymptomatic group and other group.2.To collect the clinical data of patients with combined cerebral vascular reconstruction(STAMCA+EDMS)and cerebral hyperinflation syndrome after operation,including clinical manifestations,signs,occurrence time,duration,Suzuki classification,history of hypertension,and analyze the risk factors of CHS.Results:1)275 patients with cocoyam disease were included in the study,132 males and143 females.males to females ratio was 1:1.1.minimum age 3 years,maximum age87 years,the average age was 48.3 ± 10.7 years old,and the peak incidence was shown in ages 41-50.2)Patient distribution showed obvious aggregation,with high incidence around Loyang Lake and its tributaries,especially in Gandhian River basin,and low incidence in mountainous areas.3)Grouping: 137 cases(49.8%)in the hemorrhage group,with headache,disturbance of consciousness,limb weakness/hemisphere as the main first symptoms and signs.In the cerebral alchemist group,116 cases(42.2%)had dizziness as the main first symptom.Other symptoms included TIA,limb fatigue/paraplegia,limb numbness and poor fine function.In theasymptomatic group,12 cases(4.4%)were found mainly by physical examination and stroke screening.In the other group,10 cases(3.6%)had headache as the first symptom,no involuntary movement,epilepsy and other clinical symptoms.4)In the cerebral hemorrhage group,basal ganglia hemorrhage,temporal lobe hemorrhage and ventricular hemorrhage were the most common sites.The thalami hemorrhage easily broke into the ventricle.In the cerebral alchemist group,the infarction of the lateral ventricle,the Formosa oval,and the watershed was the most common.5)50patients(54 hemispheres)with cocoyam disease underwent STA-CA+EDMS,18 on the left,36 on the right,36 patients in the chemise group(40 patients)and bleeding group(14 patients),no other groups and The patients in the asymptomatic group underwent surgery,21 males and 29 females,with an average age of 47.0±9.9years,13 patients(13/54 24.1%)had CHS after operation,CHS in patients without bilateral surgery,6 males and 7 females,with an average age of 38.7 years.11.5 years old.Among the 13 patients,1 had arachnophobia hemorrhage and subatomic hemorrhage after operation,1 had epileptic seizure 6 hours after operation,and the rest had CHS more than 2 days after operation,which could be manifested as limb weakness,aphasia,poor mental reaction after operation,dysphasia,salivation and so on.Conclusion:1.In this study,the peak incidence was shown in ages 41-50,with a single peak distribution,and the ratio of male to female was 1:1.1.2.Cocoyam disease is locally clustered in Jungian province.The incidence of cocoyam disease is high in the areas around Loyang Lake and its tributaries,especially in Gandhian River Basin,and low in mountainous areas.3.The risk factors related to cerebral hyperinflation syndrome were age,mean arterial pressure and surgical side.The time of occurrence was inversely proportional to the duration of operation.