Spicy foods triggering clinical symptoms in Moyamoya angiopathy

Dubey, Souvik; Ghosh, Ritwik; Chatterjee, Subhankar; Dubey, Mahua Jana; Ray, Biman Kanti; Das, Shambaditya; Chatterjee, Apratim; Lahiri, Durjoy; Kraemer, Markus

doi:10.23736/s0390-5616.20.05030-4

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…Moreover, exhaustion of the collaterals is associated with a significant risk of hemodynamic stroke [ 7 ]. Vasoactive drugs or causative factors, such as hyperventilation during sexual intercourse, singing, eating spicy food, or sudden blood pressure reduction, can trigger collapse of these compensatory networks [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

The angiographic presentation of European Moyamoya angiopathy

2021

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Background and purpose Little is known about the angiographic presentation of Moyamoya angiopathy (MMA) in non-Asian patients. Methods Conventional cerebral angiograms from 155 Caucasian patients diagnosed as MMA were analyzed with respect to extracranial champagne bottle neck sign, Suzuki stages, collateral status, as well as presence of aneurysms and posterior cerebral artery stenosis. Results In 84 of 155 angiograms, the extracranial carotid artery was visualized, in 65 of them (77.4%), a champagne bottle neck sign was noted. Of the 278 analyzable hemispheres, 13.7%,11.2%, 37.8%, 27.3%, 8.6%, and 1.4% were classified as Suzuki stage I, stage II, stage III, stage IV, stage V, and stage VI, respectively. Among 280 hemispheres, in 53 hemispheres (18.9%) isolated basal collaterals (pathway I) and in 104 hemispheres (37.1%) choroidal and pericallosal collaterals (including basal collaterals, pathway II) were found. In 74 hemispheres (26.4%) ethmoidal collaterals (pathways III), and in 17 hemispheres (6.1%) vault collaterals were visualized. Patients with higher Suzuki stages IV–VI (p = 0.008) and ethmoidal collaterals (p < 0.001) suffered more often from cerebral hemorrhage. Transient ischemic attacks occurred more frequently in patients with Suzuki stage I to III (p < 0.001). In 10 of 155 patients (6.5%), the angiogram revealed a cerebral aneurysm. In 13 patients (8.4%), a stenotic P1 segment of the posterior cerebral artery was found. Conclusions This is so far the largest observational study about angiography in Caucasian European MMA patients. A comparison with Asian data indicates similarity of disease in Caucasian and Asian patients.

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Section: Discussionmentioning

confidence: 99%

The angiographic presentation of European Moyamoya angiopathy

2021

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“…Besides many factors including dehydration, systemic hypotension, recent infection, hot bath, vigorous exercise, emotional outburst, increased body temperature, crying or hyperventilation can potentiate precipitation of symptoms of MMA by causing transient cerebral hypoperfusion. Infection with SARS-CoV2 and associated hemodynamic stress with emotional disruption and cytokine storm could act as precipitating factors for MMA [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The aggravation of TIA symptoms were clinically more significant than occurrence of breakthrough seizures, since focal motor seizure often are residual signs independent from the perfusion status, whereas TIA represents hemodynamic insufficiency which probably precipitated in the background of hemodynamic stress and SARS-CoV2 infection [ 5 , 6 , 15 ]. Moreover, in MMA, it may be extremely difficult to interpret ischemic events, since many MRI-evident ischemic lesions can be clinically silent, while clinical TIA often can be associated with cerebral infarction on brain imaging [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Impact of COVID-19 pandemic in natural course of Moyamoya Angiopathy: an experience from tertiary-care-center in India

Das

Ray

Ghosh

et al. 2021

Egypt J Neurol Psychiatry Neurosurg

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Background COVID-19 mediated immune dysregulation and cytokine storm can precipitate and aggravate Moyamoya angiopathy (MMA), influencing its disease course. This index study was undertaken to prospectively evaluate the status of neurological symptoms of MMA in relation to COVID-19 affection. Methodology and results Follow-up MMA patients of institute’s Stroke-clinic were telephonically interview from 24th March to 30th September, 2020. The first call familiarized them with COVID-19 symptoms and neurological manifestations of MMA, followed by monthly-calls with predesigned questionnaire. Patients with suggestion of COVID-19 underwent nasopharyngeal-swab-testing for COVID-19 Reverse transcription-polymerase chain reaction (RT-PCR) positive cases were subjected to antibody levels for COVID-19 Enzyme-linked immunoassay (ELISA) 8–12 weeks after recovery. During symptomatic phase till 14 days of asymptomatic, they were contacted daily/alternate day. Any new onset/worsening of neurological symptoms were noted. The baseline clinico-radiological details were obtained from stroke-clinic registery. Subsequently, all data were analyzed and compared using descriptive statistics. Seventy four of 104 MMA patients could be contacted and enrolled. The mean age, time since last follow-up and compliance to previously prescribed medication were 23.5 ± 16.1 years, 9.2 ± 1.7 months and 90.5% (n = 67), respectively. Aggravation/new onset neurological symptom were seen in 64.3% (n = 9) of COVID-19 positive MMA (n = 14), of which 8 were seen among the 11 pediatric COVID-19 positive MMA [(Transient ischemic attacks) TIA-4, TIA with headache-1, seizure-2, stroke causing mortality-1]. Conclusion COVID-19 infection can potentiate MMA causing significant morbidity and mortality, especially in children. Providing optimal care for severe diseases (such as MMA) in developing countries during pandemic remains a challenge.

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“…The recent epidemiological studies from around the globe have hinted toward a trend of the shift of the highest peak of incidence from children to adults, probably due to increased prevalence of comorbid stroke in adults and reclassification of previously misdiagnosed MMA for atherosclerotic disease due to improved diagnostic tools availability lately among adults (4,7,10,17). However, for reasons unknown, childhood MMA peak remains predominant in our (53)(54)(55). We observed a substantial number of patients (41.3%) with a history of an immediate precipitating factor in close temporal association to the onset of symptoms.…”

Section: Overallmentioning

confidence: 99%

Epidemiology of Moyamoya Angiopathy in Eastern India

et al. 2022

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IntroductionMoyamoya angiopathy (MMA) is a chronic, progressive intracranial vasculopathy with variation in prevalence and clinical manifestations across different populations. This study was aimed to estimate the frequency of MMA as an etiology of stroke and its epidemiological features in the largest cohort of MMA patients in India.MethodA single-centered cross-sectional observational study over a period of 5 years (2016–2021) was undertaken among consecutive stroke and transient ischemic attack (TIA) patients to look for the presence of MMA angiographically. Each patient with angiographically proven MMA was further evaluated for demographic, clinical, and radiological characteristics.ResultsAmong 10,250 consecutive stroke and TIA patients (ischemic = 78%, hemorrhagic = 22%), frequency of MMA was 1.56% (n = 160); 15.3% among children. Female preponderance (Male:Female = 1:1.4) was noted among 160 MMA patients, with bimodal age distribution, first peak at 3–8 years, and a shorter second peak at 41–47 years. Childhood-onset MMA was seen in 75 (46.9%) with commonest initial neurological symptom of fixed-motor-weakness (44.0%), followed by TIA (26.7%); while 85 (53.1%) had adult-onset MMA with fixed-motor-weakness (50.6%) followed by headache (24.7%) as the predominant initial neurological symptom; seizure significantly higher in children (p < 0.001) and headache in adults (p = 0.012). Transient and fixed neurological manifestations constituted 87.5 and 69.4% respectively, of symptoms throughout the disease course. Cerebral infarction (45.0%) and TIA (21.9%) were the commonest types of MMA. On brain imaging, infarction was noted in 80.6%, hemorrhage in 11.3%, significantly higher among adults (p < 0.001). Cortical infarct and Gyral pattern were commoner in children (p = 0.004), subcortical infarcts in adults (p = 0.018). Frequent Suzuki staging observed was stage 4 (31.3%), followed by stage 3 (30.0%). Involvement of posterior circulation was detected in 55.6%, brain atrophy at the time of diagnosis was seen in 65.0%.ConclusionMMA is an important etiological consideration in patients with stroke, especially in children. It can present with a myriad of transient neurological symptoms, frequently overlooked, leading to delayed diagnosis, and contributing to socio-economic burden. Indian MMA showed aberrations in its gender predisposition, age distribution, frequency of familial cases, disease manifestation, and type of stroke, in comparison to its Japanese and Caucasian counterparts pointing to the inter- and intra-continent differences of MMA phenotype. Future development of the Indian MMA national registry is of essence.

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Spicy foods triggering clinical symptoms in Moyamoya angiopathy

Cited by 9 publications

References 16 publications

The angiographic presentation of European Moyamoya angiopathy

The angiographic presentation of European Moyamoya angiopathy

Impact of COVID-19 pandemic in natural course of Moyamoya Angiopathy: an experience from tertiary-care-center in India

Epidemiology of Moyamoya Angiopathy in Eastern India

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