Moyamoya Disease in Pregnancy: A 20-Year Single-Center Experience and Literature Review

Inayama, Yoshihide; Kondoh, Eiji; Chigusa, Yoshitsugu; Io, Shingo; Funaki, Takeshi; Matsumura, Noriomi; Miyamoto, Susumu; Mandai, Masaki

doi:10.1016/j.wneu.2018.10.071

Cited by 31 publications

(24 citation statements)

References 64 publications

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“…According to previous studies, cerebral hemorrhage in pregnant women with Moyamoya occurs mainly in the second trimester of pregnancy, and cerebral ischemia occurs mainly after delivery. [9] The cause of CVD after delivery in women with Moyamoya is not known yet, but increased cardiac output is maintained 24-48 hours after delivery and only returns to normal within 10 days of delivery. It is hypothesized that the increase coagulability and the decrease in cerebral blood ow following the lower cardiac output cause ischemic cerebral disease after delivery in Moyamoya.…”

Section: Discussionmentioning

confidence: 99%

“…[1] In Korea, the prevalence of Moyamoya disease 16.1 cases per 100,000 people in 2011 and the incidence was 2.3 cases per 10,000 people from 2007 to 2011. [1,6] It is more common in women than in men [2,3,7,8], at a ratio of 1.8:1 [9], and its prevalence is higher in children and in the second and third quarters of life. [1] As it is common among women of childbearing age [2,8], special care is required in the management of Moyamoya in women before and after pregnancy.…”

mentioning

confidence: 99%

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The Risk for Future Cerebrovascular Disease in Pregnant Women With Moyamoya Disease: A Nationwide Population-Based Study in South Korea

Jeong

Jung

Noh

et al. 2021

Preprint

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Background: Physiologic changes during pregnancy affect the development of postpartum cerebrovascular disease (CVD) in women with Moyamoya disease (MMD). Due to the rare prevalence of MMD and large regional variations, large-scale studies on the risk of CVD after delivery have not been conducted. The aim of this study was to evaluate whether women with MMD have an increased risk of CVD after delivery.Methods: Research data was collected from the National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients delivered in Korea from 2007 to 2014 were enrolled. We classified women as CVD if they were diagnosed with stroke and/or cerebral infarction and/or intracranial hemorrhage and/or subarachnoid hemorrhage between delivery and December 31, 2016. To evaluate adjusted hazard ratio for CVD in women with MMD, we used multivariate Cox proportional hazard regression.Results: Among 3,611,216 Korean women who had delivery, 382 had Moyamoya disease. When compared to women without MMD, women with MMD had a higher prevalence of pregestational diabetes and chronic hypertension. Also, women with MMD had a significantly higher incidence of cesarean section, pregnancy-induced hypertension, and gestational diabetes mellitus (p<0.0001, <0.0001, 0.02, respectively). Among women with MMD, a total of 246(64.4%) women developed CVD within the follow-up postpartum period, and 87.8% occurred within 2 years of postpartum. Women with MMD were associated with an increased risk of CVD in later (adjusted HR 108.24; 95% CI, 95.37-122.86) after adjusting for maternal age, parity, pregnancy-induced hypertension, gestational diabetes mellitus, pregestational diabetes, chronic hypertension.Conclusion: Our study showed that the incidence of CVD after delivery was higher in women with MMD. Therefore, we have to have more cautions of women with MMD and provide long-term postpartum surveillance

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Risk for Future Cerebrovascular Disease in Pregnant Women With Moyamoya Disease: A Nationwide Population-Based Study in South Korea

Jeong

Jung

Noh

et al. 2021

Preprint

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“…This is the delivery route of choice to prevent intracranial hemorrhage due to hypertension during labor. General anesthesia and neuraxial anesthesia have been reported as successful for the cesarean section [67][68][69][70][71]. However, both techniques are associated with sudden hypotension which may progress to ischemic events.…”

Section: Anesthetic Consideration In the Obstetric Patient With MMDmentioning

confidence: 99%

Perioperative Considerations for Revascularization and Non-Revascularization Surgeries in Moyamoya Disease

Khan¹,

Hassan²,

Aboobacker³

et al. 2021

Moyamoya Disease - A Disease to Count on in Your Daily Practice

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Moyamoya disease is a rare, progressive cerebrovascular occlusive disease; characterized by narrowing of the distal internal carotid arteries and their branches. The incidence is high in East Asians and most commonly presents in the first and fourth decade of life. Its symptoms are headaches, seizures, transient neurological deficits, and cognitive decline. Medical management is based on treating the symptoms and includes antiplatelet and anti-seizure medications. Surgical revascularization is the mainstay of treatment. Unique pathophysiology of moyamoya disease necessitates neuro-anesthesiologists to formulate an individualized plan perioperatively. The overriding goal of perioperative anesthetic management of moyamoya disease is to ensure optimal cerebral perfusion and protection. Maintenance of normotension, normocarbia, normo-oxygenation, normothermia, and euvolemia is the cornerstone during the perioperative period. Perioperative adequate analgesia is crucial to prevent cerebral ischemia and allows close neurological monitoring. This chapter reviews perioperative anesthetic management of patients with moyamoya disease.

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“…23 A major risk factor for stroke-particularly hemorrhagic stroke-during pregnancy is uncontrolled hypertension, suggesting that careful obstetrical monitoring and early steps to control blood pressure may be important. 24 While many centers choose cesarean section as the default method of delivery, healthy vaginal births are certainly possible, with the caveat that pain management (often with an epidural catheter) and avoidance of hyperventilation are crucial. 25 Overall, for moyamoya patients already revascularized, > 95% of mothers with moyamoya disease have good neurological outcomes after pregnancies, with all delivered children reported healthy.…”

Section: Surgical/dental Procedures/pregnancymentioning

confidence: 99%

Transition to Adulthood for Pediatric Moyamoya Patients

Scott

Smith

2020

Journal of Pediatric Neurology

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Moyamoya is a progressive arteriopathy of the intracranial vasculature, predominantly affecting the terminal branches of the internal carotid artery. Treatment is predicated on surgical revascularization to reduce the risk of stroke. For patients diagnosed and treated as children, it is important to recognize the long-term implications of the disease, for example, that moyamoya is treatable, but not curable. Pediatric moyamoya patients face unique challenges as they transition to adulthood as a consequence of the chronic nature of this disorder. Successful long-term care requires a strategy that incorporates ongoing longitudinal disease monitoring, coordination of care between physician teams, and anticipation of socioeconomic factors that change over time. This article provides an approach to transition care to adult caregivers for pediatric moyamoya patients with a specific focus on the three key stakeholders in the process: the neurosurgeon, the primary care physician, and the individual patient.

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Moyamoya Disease in Pregnancy: A 20-Year Single-Center Experience and Literature Review

Cited by 31 publications

References 64 publications

The Risk for Future Cerebrovascular Disease in Pregnant Women With Moyamoya Disease: A Nationwide Population-Based Study in South Korea

The Risk for Future Cerebrovascular Disease in Pregnant Women With Moyamoya Disease: A Nationwide Population-Based Study in South Korea

Perioperative Considerations for Revascularization and Non-Revascularization Surgeries in Moyamoya Disease

Transition to Adulthood for Pediatric Moyamoya Patients

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