Imaging of Moyamoya disease/syndrome
Imaging: Thread-like intracranial ICA/MCA with attenuated branches and “puff of smoke” appearance on DSA
Complications:
▶️Ischemia (classically watershed)
▶️Hemorrhage
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Imaging: Thread-like intracranial ICA/MCA with attenuated branches and “puff of smoke” appearance on DSA
Complications:
▶️Ischemia (classically watershed)
▶️Hemorrhage
Learning points in 🧵 🧠
#Neurosurgery #Neurology #peds #MedTwitter x.com
Terminology: “Moyamoya” “puff of smoke” ▶️name given due to the appearance on cerebral angiogram (from cloud-like filling of extensive collaterals)
▶️Moyamoya DISEASE is idiopathic
▶️Moyamoya SYNDROME is acquired 2/2 many etiologies (atherosclerosis, FMD, radiation, etc.)
▶️Moyamoya DISEASE is idiopathic
▶️Moyamoya SYNDROME is acquired 2/2 many etiologies (atherosclerosis, FMD, radiation, etc.)
Imaging:
CT:
▶️May see the complications (atrophy, hemorrhage, ischemia)
MRI:
▶️High signal in sulci on FLAIR 2/2 slow flow within collaterals
▶️Leptomeningeal enhancement
CTA/MRA:
▶️Thread-like caliber or occluded intracranial ICA/MCA with attenuated branches
▶️Collaterals x.com
CT:
▶️May see the complications (atrophy, hemorrhage, ischemia)
MRI:
▶️High signal in sulci on FLAIR 2/2 slow flow within collaterals
▶️Leptomeningeal enhancement
CTA/MRA:
▶️Thread-like caliber or occluded intracranial ICA/MCA with attenuated branches
▶️Collaterals x.com
DSA:
▶️severely stenotic/occluded intracranial ICA/MCA with tangled vessels (collaterals)
▶️puff of smoke” appearance on arterial phase x.com
▶️severely stenotic/occluded intracranial ICA/MCA with tangled vessels (collaterals)
▶️puff of smoke” appearance on arterial phase x.com
Complications:
▶️Infarcts (classically watershed) from hypo-perfusion
▶️Hemorrhage (those robust collaterals can rupture)
▶️ipsilateral atrophy from chronic ischemia x.com
▶️Infarcts (classically watershed) from hypo-perfusion
▶️Hemorrhage (those robust collaterals can rupture)
▶️ipsilateral atrophy from chronic ischemia x.com
Treatment (not my expertise):
▶️ECA-MCA bypass (2-options)
1. DIRECT anastomoses of ECA (usually superficial temporal artery to MCA)
2. INDIRECT (Encephaloduroarteriomyosynangiosis) STA branches and soft tissues are placed on pial surface of brain -> results in angiogenesis x.com
▶️ECA-MCA bypass (2-options)
1. DIRECT anastomoses of ECA (usually superficial temporal artery to MCA)
2. INDIRECT (Encephaloduroarteriomyosynangiosis) STA branches and soft tissues are placed on pial surface of brain -> results in angiogenesis x.com
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