Doença cerebrovascular tipo "moyamoya"

Brandt, Reynaldo A.; Tilbery, Charles P.; Rodriguez, Juan R. C.

doi:10.1590/S0004-282X1976000300007

Resumos

É relatado o caso de um paciente masculino, branco, 34 anos, que apresentou hemorragia meníngea sem sinais de comprometimento cerebral. A carotidoangiografia direita mostrou as alterações típicas do "moyamoya", com estenose da artéria carótida interna ao nível do sifão, acima da origem da artéria comunicante posterior; há uma rede vascular angiomatosa anormal projetando-se na base do cérebro, da qual nascem as artérias cerebrais anterior e média, sendo as artérias comunicante e cerebral posterior hipertrofiadas e de trajeto tortuoso; há anastomoses meningo-corticiais, sendo as artérias meníngeas hipertrofiadas. A carotidoangiografia esquerda mostrou hipertrofia das artérias carótidas comum e interna, com contrastação de ambas as artérias cerebrais anteriores e médias a partir deste lado; a artéria comunicante anterior é do tipo fetal e há a presença anômala da artéria cerebral anterior mediana do corpo caloso. Estes dados apoiam a teoria segundo a qual a doença constitui anomalia do desenvolvimento vascular encefálico, não tendo sido encontrado outro caso na literatura com hipertrofia vicariante da artéria carótida interna contralateral à da lesão típica do "moyamoya".

The case of a 34-year-old Caucasian male with subarachnoid hemorrahge is reported. The right carotid arteriogram shows the typical internal carotid artery occlusion at the syphon, with an abnormal vascular network at the base of the brain; the right anterior and middle cerebral arteries fill from the vascular network and through meningocortical anastomoses; the right posterior communicating and cerebral arteries are tortuous and hypertrophic. The left carotid arteriogram shows hypertrophy of the common and internal carotid arteries; both anterior and middle cerebral arteries fill from this side; the anterior communicating artery is thick (foetal type) and a median anterior cerebral artery to the corpus callosum is present. It is the authors' view that the "moyamoya" disease is a congenital one, since the abnormal vascular network at the base of the brain would not be necessary, in this case, to preserve good collateral circulation to the right cerebral hemisphere. No other case with the typical findings of "moyamoya" disease on one side and hypertrophy of the carotid arteries on the other was found in the literature.

Doença cerebrovascular tipo "moyamoya"

Cerebrovascular "moyamoya" disease: a case report and review of the literature

Reynaldo A. Brandt^I; Charles P. Tilbery^II; Juan R. C. Rodriguez^I

^IUnidade Neurológica e Neurocirúrgica Praça Oswaldo Cruz 138, cj. 73/74 04004 São Paulo, SP Brasil. Neurocirurgião

^IIUnidade Neurológica e Neurocirúrgica Praça Oswaldo Cruz 138, cj. 73/74 04004 São Paulo, SP Brasil. Neurologista

RESUMO

É relatado o caso de um paciente masculino, branco, 34 anos, que apresentou hemorragia meníngea sem sinais de comprometimento cerebral. A carotidoangiografia direita mostrou as alterações típicas do "moyamoya", com estenose da artéria carótida interna ao nível do sifão, acima da origem da artéria comunicante posterior; há uma rede vascular angiomatosa anormal projetando-se na base do cérebro, da qual nascem as artérias cerebrais anterior e média, sendo as artérias comunicante e cerebral posterior hipertrofiadas e de trajeto tortuoso; há anastomoses meningo-corticiais, sendo as artérias meníngeas hipertrofiadas. A carotidoangiografia esquerda mostrou hipertrofia das artérias carótidas comum e interna, com contrastação de ambas as artérias cerebrais anteriores e médias a partir deste lado; a artéria comunicante anterior é do tipo fetal e há a presença anômala da artéria cerebral anterior mediana do corpo caloso. Estes dados apoiam a teoria segundo a qual a doença constitui anomalia do desenvolvimento vascular encefálico, não tendo sido encontrado outro caso na literatura com hipertrofia vicariante da artéria carótida interna contralateral à da lesão típica do "moyamoya".

SUMMARY

The case of a 34-year-old Caucasian male with subarachnoid hemorrahge is reported. The right carotid arteriogram shows the typical internal carotid artery occlusion at the syphon, with an abnormal vascular network at the base of the brain; the right anterior and middle cerebral arteries fill from the vascular network and through meningocortical anastomoses; the right posterior communicating and cerebral arteries are tortuous and hypertrophic. The left carotid arteriogram shows hypertrophy of the common and internal carotid arteries; both anterior and middle cerebral arteries fill from this side; the anterior communicating artery is thick (foetal type) and a median anterior cerebral artery to the corpus callosum is present. It is the authors' view that the "moyamoya" disease is a congenital one, since the abnormal vascular network at the base of the brain would not be necessary, in this case, to preserve good collateral circulation to the right cerebral hemisphere. No other case with the typical findings of "moyamoya" disease on one side and hypertrophy of the carotid arteries on the other was found in the literature.

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Unidade Neurológica e Neurocirúrgica Praça Oswaldo Cruz 138, cj. 73/74 04004 São Paulo, SP Brasil.

1. BALBO, R. J.; SARIAN, L.; SPERLECU, A. & RIBEIRO, L. A. O. Doença oclusiva progressiva das artérias cerebrais (moyamoia). Seara Med. Neuroc. (S. Paulo) 2:166, 1972.
2. BREMER, J. L. Congenital aneurysms of the cerebral arteries. Arch. Path. (Chicago) 35:819, 1943.
3. DAMME van, W.; BEECKMAN, P. & VERBRUGGEN, R. Moyamoya syndrome probably associated with hydrocephalus. Neuroradiology 9:39, 1975.
4. DILLON, J. D.; STOKES, H. & MEIROWSKY, A. M. Moyamoya disease. Surg. Neurol. 3:233, 1975.
5. GALLIGIONI, F.; ANDRIOLT, G. C; MARIN, G.; BRIANI, S. & IRAC1, G. Hypoplasia of the internal carotid artery associated with cerebral pseudo-angiomatosis. Amer. J. Roentgenol. 112:251, 1971.
6. HANDA, J. & HANDA, H. Progressive cerebral arterial occlusive disease: analysis of 27 cases. Neuroradiology 3:119, 1972.
7. IIVANAINEN, M.; VUOLIO, M. & HALONEN, V. Occlusive disease of intracranial main arteries with collateral networks (moyamoya disease) in adults. Acta Neurol. Scandinav. 49:307, 1973.
8. KRAYENBÜHL, H. A. The moyamoya syndrome and the neurosurgeon. Surg. Neurol. 4:353, 1975.
9. KUDO, T. Spontaneous occlusion of the circle of Willis. A disease apparently confined to japanese. Neurology (Minneapolis) 18:485, 1968.
10. LEE, M. L. K. & CHEUNG, E. M. T. Moyamoya disease as a cause of subarachnoid haemorrhage in Chinese. Brain 96:623, 1973.
11. LEEDS, N. E. & ABBOTT, K. H. Collateral circulation in cerebrovascular disease in childhood via rete mirabile and perforating branches of anterior choroidal and posterior cerebral arteries. Radiology 85:628, 1965.
12. LEPOIRE, J.; TRIDON, P.; MONTAUT, J.; HEPNER, J.; RENARD, M. & PICARD, L. Malformations angiomateuses artério-artérielles du système carotidien. Neurochirurgie 15:5, 1969.
13. NISHIMOTO, A. & TAKEUSHI, S. Abnormal cerebrovascular network related to the internal carotid arteries. J. Neurosurg. 29:255, 1968.
14. NISHIMOTO, A. & TAKEUSHI, S. Moyamoya disease. Abnormal cerebrovascular network in the cerebral basal region. In VINKEN, P. J. & BRUYN, G. W. Handbook of Clinical Neurology, vol. 12, North-Holland, Amsterdan, 1972, p. 352.
15. PADGET, D. H. The circle of Willis. Its embriology and anatomy. In DANDY, W. Intracranial arterial aneurysms. Comstock, 1944, p. 67.
16. PERRET, J.; CROUZET, G.; PELLAT, J.; PASQUIER, B.; LARRIBAU, E. & CHIROSSEL, J. P. Sténose sylvienne avec réseaux de type moya moya. Rev. Neurol. (Paris) 131:243, 1975.
17. PRENSKY, A. L. .& DAVIS, D. O. Obstruction of major cerebral vessels in early childhood without neurological signs. Neurology (Minneapolis) 20:945, 1970.
18. SMITH, K. R.; NELSON, J. S. & DOOLEY, J. M. Bilateral "hypoplasia" of the internal carotid arteries. Neurology (Minneapolis) 18:1149, 1968.
19. SUZUKI, J. & TAKAKU, A. Cerebrovascular "moyamoya" disease. Arch. Neurol. (Chicago) 20:288, 1969.
20. SUZUKI, J. & KODAMA, N. Cerebrovascular "moyamoya" disease. Angiology 22:223, 1971.
21. TAVERAS, J. M. Multiple progressive intracranial arterial occlusions: a syndrome of children and young adults. Amer. J. Roentgenol. 106:235, 1969.
22. URBÁNEK, K.; FARKOVA, H. & KLAUS, E. Nishimoto-Takeushi-Kudo disease: case report. J. Neurol. Neurosurg. Psychiat. 33:671, 1970.
23. VUIA, O.; ALEXIANU, M. & GABOR, S. Hypoplasia and obstruction of the circle of Willis in a case of atypical cerebral hemorrhage and its relationship to Nishimoto's disease. Neurology (Minneapolis) 20:361, 1970.

Datas de Publicação

Publicação nesta coleção
26 Fev 2013
Data do Fascículo
Set 1976

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BALBO, R. J.; SARIAN, L.; SPERLECU, A. & RIBEIRO, L. A. O. Doença oclusiva progressiva das artérias cerebrais (moyamoia). Seara Med. Neuroc. (S. Paulo) 2:166, 1972.

[2] 2. BREMER, J. L. Congenital aneurysms of the cerebral arteries. Arch. Path. (Chicago) 35:819, 1943.

[3] 3. DAMME van, W.; BEECKMAN, P. & VERBRUGGEN, R. Moyamoya syndrome probably associated with hydrocephalus. Neuroradiology 9:39, 1975.

[4] 4. DILLON, J. D.; STOKES, H. & MEIROWSKY, A. M. Moyamoya disease. Surg. Neurol. 3:233, 1975.

[5] 5. GALLIGIONI, F.; ANDRIOLT, G. C; MARIN, G.; BRIANI, S. & IRAC1, G. Hypoplasia of the internal carotid artery associated with cerebral pseudo-angiomatosis. Amer. J. Roentgenol. 112:251, 1971.

[6] 6. HANDA, J. & HANDA, H. Progressive cerebral arterial occlusive disease: analysis of 27 cases. Neuroradiology 3:119, 1972.

[7] 7. IIVANAINEN, M.; VUOLIO, M. & HALONEN, V. Occlusive disease of intracranial main arteries with collateral networks (moyamoya disease) in adults. Acta Neurol. Scandinav. 49:307, 1973.

[8] 8. KRAYENBÜHL, H. A. The moyamoya syndrome and the neurosurgeon. Surg. Neurol. 4:353, 1975.

[9] 9. KUDO, T. Spontaneous occlusion of the circle of Willis. A disease apparently confined to japanese. Neurology (Minneapolis) 18:485, 1968.

[10] 10. LEE, M. L. K. & CHEUNG, E. M. T. Moyamoya disease as a cause of subarachnoid haemorrhage in Chinese. Brain 96:623, 1973.

[11] 11. LEEDS, N. E. & ABBOTT, K. H. Collateral circulation in cerebrovascular disease in childhood via rete mirabile and perforating branches of anterior choroidal and posterior cerebral arteries. Radiology 85:628, 1965.

[12] 12. LEPOIRE, J.; TRIDON, P.; MONTAUT, J.; HEPNER, J.; RENARD, M. & PICARD, L. Malformations angiomateuses artério-artérielles du système carotidien. Neurochirurgie 15:5, 1969.

[13] 13. NISHIMOTO, A. & TAKEUSHI, S. Abnormal cerebrovascular network related to the internal carotid arteries. J. Neurosurg. 29:255, 1968.

[14] 14. NISHIMOTO, A. & TAKEUSHI, S. Moyamoya disease. Abnormal cerebrovascular network in the cerebral basal region. In VINKEN, P. J. & BRUYN, G. W. Handbook of Clinical Neurology, vol. 12, North-Holland, Amsterdan, 1972, p. 352.

[15] 15. PADGET, D. H. The circle of Willis. Its embriology and anatomy. In DANDY, W. Intracranial arterial aneurysms. Comstock, 1944, p. 67.

[16] 16. PERRET, J.; CROUZET, G.; PELLAT, J.; PASQUIER, B.; LARRIBAU, E. & CHIROSSEL, J. P. Sténose sylvienne avec réseaux de type moya moya. Rev. Neurol. (Paris) 131:243, 1975.

[17] 17. PRENSKY, A. L. .& DAVIS, D. O. Obstruction of major cerebral vessels in early childhood without neurological signs. Neurology (Minneapolis) 20:945, 1970.

[18] 18. SMITH, K. R.; NELSON, J. S. & DOOLEY, J. M. Bilateral "hypoplasia" of the internal carotid arteries. Neurology (Minneapolis) 18:1149, 1968.

[19] 19. SUZUKI, J. & TAKAKU, A. Cerebrovascular "moyamoya" disease. Arch. Neurol. (Chicago) 20:288, 1969.

[20] 20. SUZUKI, J. & KODAMA, N. Cerebrovascular "moyamoya" disease. Angiology 22:223, 1971.

[21] 21. TAVERAS, J. M. Multiple progressive intracranial arterial occlusions: a syndrome of children and young adults. Amer. J. Roentgenol. 106:235, 1969.

[22] 22. URBÁNEK, K.; FARKOVA, H. & KLAUS, E. Nishimoto-Takeushi-Kudo disease: case report. J. Neurol. Neurosurg. Psychiat. 33:671, 1970.

[23] 23. VUIA, O.; ALEXIANU, M. & GABOR, S. Hypoplasia and obstruction of the circle of Willis in a case of atypical cerebral hemorrhage and its relationship to Nishimoto's disease. Neurology (Minneapolis) 20:361, 1970.