Artikel
Circulating Microemboli (CME) in patients with Ischemic-Type Moyamoya Disease (MMD)
Zirkulierende Mikroemboli bei Patienten mit adulter Moyamoya - Erkrankung vom ischämischen Typ
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
MMD as a rare steno-occlusive cerebrovascular disease is assumed to present with ischemic symptoms due to hemodynamic insufficiency. However, alternative or coexisting mechanisms of cerebral ischemia, such as CME, may contribute to the clinical symptoms. The incidence of CME and the coexisting degree of hemodynamic compromise were studied in symptomatic patients with MMD.
Methods
Twenty-four patients (17 female, 7 male; mean age + standard deviation: 33 + 13 years) with clinical symptoms attributable to acute (TIA or stroke) or chronic ischemia (chronic headache, epileptic seizures, mental retardation and personality changes) and angiographic features of MMD (20 definite form, 4 probable MMD; 22 patients "late stage" MMD, 2 patients "early stage" MMD) were enrolled in the present study. Patients underwent functional rCBF studies (estimation of hemodynamic compromise) and Transcranial Doppler Sonography (CME detection).
Results
A total of 39 parallel rCBF and TCD studies were obtained in 21 patients. Hemodynamic compromise was observed in 35/39 (89%) hemispheres studied. TCD studies detected CME in 3 patients (12.5 %), with a total frequency of 3 (7.7 %) for 39 hemispheres. All patients with CME showed hemodynamic compromise in functional rCBF studies. The CME counts ranged from 2 to 17 CMEs per 20 minutes. CME occurred in late stage MMD patients only once, while both cases with early stage MMD demonstrated multiple CME (2/2; 100%).
Conclusions
CME possibly contributes to the clinical symptoms in patients with MMD in the early stage. Since CME appears to exist in conjunction with hemodynamic compromise, therapeutic strategies should focus on the restoration of rCBF and the prevention of cerebral microembolism in this subgroup of patients.