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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 2  |  Page : 202-203

Moyamoya disease presenting with acute subdural hemorrhage


Department of Neurosurgery, Medica North Bengal Clinic, Siliguri, West Bengal, India

Date of Web Publication14-May-2014

Correspondence Address:
Amit Kumar Ghosh
Department of Neurosurgery, Medica North Bengal Clinic, Siliguri, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.132406

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How to cite this article:
Ghosh AK. Moyamoya disease presenting with acute subdural hemorrhage. Neurol India 2014;62:202-3

How to cite this URL:
Ghosh AK. Moyamoya disease presenting with acute subdural hemorrhage. Neurol India [serial online] 2014 [cited 2020 Apr 7];62:202-3. Available from: http://www.neurologyindia.com/text.asp?2014/62/2/202/132406


Sir,

Moyamoya disease is characterized by progressive occlusion of distal internal carotid artery and its branches resulting in ischemic infarcts and collateral formation as a compensatory mechanism [1] Angiographic appearance of this collateral network is like "puff of smoke" which in Japanese language called "moyamoya." [1] Moyamoya disease itself is very rare and is more common in Japanese population. [1],[2] This report presents a rare presentation of moyamoya disease.

A 46-year-old male presented with sudden onset loss of consciousness followed by headache and vomiting. Computed tomography scan showed right acute subdural hematoma (SDH) with mass effect [Figure 1]. Neurologic examination revealed altered mental status and left hemiparesis. Considering nontraumatic nature of hemorrhage, magnetic resonance angiography was done and it showed right internal carotid artery occlusion. As there was neurologic deterioration, right decompresive craniotomy and evacuation of SDH was done [Figure 2]. Patient had good recovery. Postoperative digital subtraction angiography had confirmed moyamoya disease [Figure 3]. He was discharged in a stable condition with future plan of revascularization.
Figure 1: Computed tomography scan showing acute subdural hemorrhage

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Figure 2: Postoperative scan showing evacuated subdural hematoma

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Figure 3: Digital subtraction angiography showing moyamoya disease

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Moyamoya disease in pediatric patients, presents with ischemic events and intracranial hemorrhage accounts only for 10%, whereas in adults intracranial hemorrhage accounts for more than 60% of cases. [3] Spontaneous acute SDH in moyamoya disease is rare and only 6 cases have been reported. [4],[5],[6],[7],[8] This is yet another case. SDH as a complication of moya and moya is due to the rupture of transdural anastomotic vessels.

 
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1.Guzman R, Lee M, Achrol A, Bell-Stephens T, Kelly M, Do HM, et al. Clinical outcome after 450 revascularization procedures for moyamoya disease. Clinical article. J Neurosurg 2009;111:927-35.  Back to cited text no. 1
    
2.Wakai K, Tamakoshi A, Ikezaki K, Fukui M, Kawamura T, Aoki R, et al. Epidemiological features of moyamoya disease in Japan: Findings from a nationwide survey. Clin Neurol Neurosurg 1997;99 Suppl 2:S1-5.  Back to cited text no. 2
    
3.Jha VC, Behari S, Singh B, Jaiswal AK. Adult hemorrhagic moyamoya disease: The paradoxical role of combined revascularization. Indian J Neurosurg 2012;1:108-16.  Back to cited text no. 3
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4.Kawakami K, Takahashi S, Sonobe M, Koshu K, Hirota S, Kusunose M. Subacute subdural hematoma associated with moyamoya phenomenon: A case report. No Shinkei Geka 1988;16:205-9.  Back to cited text no. 4
    
5.Shen WC, Lee WY. Moyamoya disease causes acute subdural hematomas and sudden death: A case report. Zhonghua Yi Xue Za Zhi (Taipei) 1998;61:619-23.  Back to cited text no. 5
    
6.Nakakita K, Tanaka S, Fukuda A, Fujii C, Kohama A, Miyasato H. Nontraumatic acute subdural hematoma caused by the rupture of transdural anastomotic vessels in moyamoya disease. No Shinkei Geka 1994;22:561-5.  Back to cited text no. 6
    
7.Takeuchi S, Ichikawa A, Koike T, Tanaka R, Arai H. Acute subdural hematoma in young patient with moyamoya disease: Case report. Neurol Med Chir (Tokyo) 1992;32:80-3.  Back to cited text no. 7
    
8.Oppenheim JS, Gennuso R, Sacher M, Hollis P. Acute atraumatic subdural hematoma associated with moyamoya disease in an African-American. Neurosurgery 1991;28:616-8.  Back to cited text no. 8
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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