Clinical Observation Of Adult Unilateral Moyamoya Disease

Objective:Through a reviewing of the medical records of patients with unilateral moyamoya disease and follow-up patient to investigate clinical features and prognosis of those disease.Methods:A restrospective review was conducted for 138 adult patients with unilateral moyamoya disease in Nanchang university first affiliated hospital between January 2008 and December2013,including their clinical data and medical imaging results.They were divided into 2 groups according to treatments:operation group(n=37) and conservative treatment group(n=28),including 21 patients undwent superficial temporal artery-middle cerebral artery anastomosis(STA-MCA).The follow-up patients were about 78 cases.The primoary follow-up events included death,recurrent stroke,improved prognosis.Results:(1) The adult unilateral moyamoya disease patients number were about 17.57% of the patients with moyamoya disease.In the 138 cases,70 cases were male,68 were female,male to female ratio was about:1.02:1.The peak incident‘s age was between 41 and 50. The average age of 46.53±9.460.Including 91 patients(65.94%) who presented bleeding,36 patients who had Intraventricular hemorrhage,35 patients who had subarachnoid hemorrhage,20 patients who had cerebral hemorrhage,23(16.66%) patients who were combined with arterial aneurysm,9 patients who were combined with thyroid gland dysfunction.108 patients were in lingmu stage Ⅱ-Ⅲ which accouted for about 78.26%.In our research,we were not find family history.(2)There were 6 patients died,5 patients were died from recurrent cerebral hemorrhage.There were 2 patients who come from surigal groups(n=21) had stroke event.The average time of recurrent stroke was about 5 years.Relatively,nine of 47 conservatively treated patients experienced recurrence stroke.The average time was about 2 years. 21 patients who undwent STA-MCA had no stroke event,concluding hemorrhagic MMD(n=8)and ischemic MMD(n=8).Ten of 21 patients underwent STA-MCA had reexamination of angiography and there were no case showed progression to the bilateral MMD.(3)There were no relevant between the prognosis and age,six,somking history,past history and abnormaol thyroid function(P〉0.05).But it was related to the stage of unilateral moyamoya disease,whether the patients complicated with aneurysm,clinical symptoms,or had surgical treatment or not(P 〈 0.05). Conclusion:(1). The adult unilateral moyamoya disease patients number were about 17.57% of the patients with moyamoya disease in our hospital.There was no difference in the sex distribution of our patients with adult unilateral moyamoya disease.(2)The patients‘ onset of unilateral moyamoya disease was in their period of lingmu stage of vascular network vigorous. The clinical features of adult unilateral moyamoya disease was bleeding.Intraventricular hemorrhage and subarachnoid hemorrhage was common.(3) Surgical revascularization(main STA-MCA)can reduce and relieve the risk of stroke recurrent.(4) The prognosis improvement of adult unilateral moyamoya disease had nothing to do with age,six,somking history,past history and abnormal thyroid function.But may be related to the stage of unilateral moyamoya disease,whether patients were complicated with aneurysm,clinical symptoms,or aceepted surgical treatment.