Advertisement

Acta Neurochirurgica

, Volume 138, Issue 11, pp 1282–1286 | Cite as

A source of haemorrhage in adult patients with moyamoya disease: The significance of tributaries from the choroidal artery

  • K. Irikura
  • Y. Miyasaka
  • A. Kurata
  • R. Tanaka
  • K. Fujii
  • K. Yada
  • S. Ran
Clinical Articles

Summary

This study concerns 19 patients over 16 years of age with Moyamoya disease. Ten cases of intracranial haemorrhage, as the initial haemorrhagic event in patients aged from 21 to 55 (haemorrhagic group) and 9 cases of ischaemic events in 18- to 53-year-old patients (ischaemic group) were included. All haemorrhages were associated with intraventricular haemorrhages (IVH); and all but one case of thalamic haemorrhage were thought to be primary IVH (2 cases of small paraventricular haemorrhage; 2 of small haemorrhages in the splenium; 5 with no intracerebral haematoma). In the 9 patients of the ischaemic group, there were 2 cases of transient ischaemic attacks and 7 of cerebral infarction. Angiographic evaluations demonstrated that the abnormal basal vessel formation and the collateral supplies from the external carotid arteries were poorly developed in both groups. In contrast, the collateral circulation via the choroidal and posterior pericallosal arteries was well demonstrated. Furthermore, marked enlargement of the choroidal arteries and the medullary arteries derived from them was seen more frequently in the haemorrhagic group. These findings suggested that the haemodynamic load in the vessels supplying the walls of the posterior parts of the ventricles and the periventricular region was increased, especially in the haemorrhagic group. Those vessels were considered to be important sites of IVH in adult patients with Moyamoya disase.

Keywords

Moyamoya disease intraventricular haemorrhage angiography choroidal artery medullary artery 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bergh RVD, Eecken HV (1968) Anatomy and embryology of cerebral circulation. Prog Brain Res 30: 1–25Google Scholar
  2. 2.
    Butler AB, Partain RA, Netsky MG (1972) Primary intraventricular haemorrhage. A mild and remediable form. Neurology 22: 675–687PubMedGoogle Scholar
  3. 3.
    Darby DG, Donnan GA, Saling MA, Walsh KW, Bladin PF (1988) Primary intraventricular haemorrhage: Clinical and neuropsychological findings in a prospective stroke series. Neurology 38: 68–75PubMedGoogle Scholar
  4. 4.
    De Reuck J (1971) The human periventricular arterial blood supply and the anatomy of cerebral infarctions. Eur Neurol 5: 321–334PubMedGoogle Scholar
  5. 5.
    Fujii K, Lenkey C, Rhoton AL Jr (1980) Microsurgical anatomy of the choroidal arteries: lateral and third ventricles. J Neurosurg 52: 165–188PubMedGoogle Scholar
  6. 6.
    Hamada J, Hashimoto N, Tsukahara T (1994) Moyamoya disease with repeated intraventricular haemorrhage due to aneurysm rupture. Report of two cases. J Neurosurg 80: 328–331PubMedGoogle Scholar
  7. 7.
    Hosoda Y, Ikeda E (1988) The pathology of the vessels around the intracranial haemorrhagic lesions in spontaneous occlusion of the circle of Willis (in Japanese). The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan, Annual Report, pp 51–54Google Scholar
  8. 8.
    Kanayama S, Niizuma H (1981) Cerebrovascular Moyamoya disease. Study of collateral circulation with microangiography and translucidation (in Japanese). In: Kawabuchi J (ed) Proc. 10th Japanese Conference on Surgery of Cerebral Stroke, Tokyo Nyuron Sha Co., pp 154–157Google Scholar
  9. 9.
    Kodama N, Suzuki J (1974) Cerebrovascular Moyamoya disease. Third report. The study on the aging of the perforating branches and the possibility of collateral pathway. Neurol Med Chir 14: 55–67Google Scholar
  10. 10.
    Kodama N, Suzuki J (1978) Moyamoya disease associated with aneurysm. J Neurosurg 48: 565–569PubMedGoogle Scholar
  11. 11.
    Konishi Y, Kadowaki C, Hara M, Takeuchi K (1985) Aneurysms associated with Moyamoya disease. Neurosurgery 16: 484–491PubMedGoogle Scholar
  12. 12.
    Margolis MT, Newton TH, Hoyt WE (1974) The posterior cerebral artery, II. Gross and roentgenographic anatomy. In: Newton TH, Potts DG (eds) Radiology of the skull and brain, vol II. Mosby, St Louis, pp 1551–1579Google Scholar
  13. 13.
    Suzuki J, Kodama N (1983) Moyamoya disease. A review. Stroke 14: 104–109PubMedGoogle Scholar
  14. 14.
    Suzuki J, Takaku A (1969) Cerebrovascular Moyamoya disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20: 288–299PubMedGoogle Scholar
  15. 15.
    Suzuki J, Kodama N, Mineura K (1976) Mechanism of symptomatic occurrence in cerebrovascular Moyamoya disease (in Japanese). No To Hinkei 28: 459–470Google Scholar
  16. 16.
    Takahashi M (1980) Magnification angiography in Moyamoya disease. New observations on collateral vessels. Radiology 136: 379–386PubMedGoogle Scholar
  17. 17.
    Takahashi M (1980) Magnification angiography of cerebral aneurysms associated with Moyamoya disease. Am J Neuroradiol 1: 547–550Google Scholar
  18. 18.
    Utsunomiya H, Hayashi T, Shojima K, Sato Y, Maehara F, Okudera T (1986) Two adult cases of Moyamoya disease with intraventricular haemorrhage. Angiographic evaluation of periventricular vascular anatomy (in Japanese). No Shinkei Geka 14: 1105–1110PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • K. Irikura
    • 1
  • Y. Miyasaka
    • 1
  • A. Kurata
    • 1
  • R. Tanaka
    • 1
  • K. Fujii
    • 1
  • K. Yada
    • 1
  • S. Ran
    • 2
  1. 1.Department of NeurosurgeryKitasato University School of MedicineKanagawaJapan
  2. 2.Department of RadiologyKitasato University School of MedicineKanagawaJapan

Personalised recommendations