Clinical symptoms of moyamoya disease and its differentiation from stroke

Moyamoya disease, also known as abnormal vascular network disease or MoYa-MoYa’s disease, has an unclear etiology and pathogenesis. It is generally believed that the disease may occur on the basis of congenital maldevelopment of the brain base arterial circle, resulting in vascular inflammation, vascular occlusion, collateral circulation proliferation, and formation of abnormal vascular networks. Clinically, symptoms such as hemiplegia and aphasia can occur.

Clinical symptoms of moyamoya disease and its differentiation from stroke
Clinical symptoms of moyamoya disease and its differentiation from stroke

Moyamoya disease is a common disease in children and young people. Clinically, sudden hemiplegia appears, alternating between left and right sides, and finally fixes on one side, resulting in hemiplegia. Some patients may also experience seizures, loss of consciousness, or headaches, vomiting. Symptoms can also include stroke-like speechlessness, facial distortion, blurred vision, involuntary limb movement, and mental disorders. The clinical manifestations of the disease also have obvious age characteristics: young children under 15 years old are more likely to show hemiplegia; adults over 16 years old are more likely to manifest symptoms of subarachnoid hemorrhage, such as severe headaches, transient coma, meningeal irritation, hemiplegia, etc.

What are the abnormal findings in the cerebral angiography examination of moyamoya disease?

Patients clinically suspected of moyamoya disease should undergo a cerebral angiography examination for diagnosis. The examination reveals severe stenosis or occlusion of the bilateral internal carotid artery upper segment and the proximal anterior and middle cerebral arteries, while the distal vascular morphology is completely normal. There is a significant capillary dilatation network in the basal ganglia region, and extensive and rich collateral circulation appears in the cerebral hemispheres. Based on the clinical manifestations and cerebral angiography examination, the diagnosis is generally not difficult.

How to treat moyamoya disease after stroke symptoms occur?

After the onset of moyamoya disease, its main symptoms such as hemiplegia, aphasia, etc. are manifestations of stroke, but it is different from stroke caused by cerebral embolism, cerebral hemorrhage, etc. This disease mainly affects children and young people, and the pathogenesis and pathology are different, so the treatment methods also vary. Moyamoya disease often occurs after complications such as intracranial vascular infections, syphilis, tuberculosis, etc., therefore, it is essential to treat the cause and primary disease, and antimicrobial, antitubercular drugs can be selected.

Adults aged 16 and above with subarachnoid hemorrhage should be treated according to the routine treatment for subarachnoid hemorrhage. If there is no primary disease cause such as infection, tuberculosis, syphilis, etc., it is considered to be of unknown cause, and hormone therapy can be applied in conjunction with vasodilators.

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