Retrospective Case Study And Chinese Medicine Syndrome Types Study Of Adult Moyamoya Disease

Objective:By analysising epidemiology,clinical manifestations,imaging features,treatment and outcome of adult patients with MMD,and summarizing TCM syndrome types of these patients at the same time,we preliminary discussed the basic pathogenesis of MMD for further increasing the understanding of this disease and providing reference basis for clinical diagnosis and treatment.Methods:1、Retrospectively collecting clinical and radiographic data of 61 adult patients with MMD from January 2005 to October 2016 in Encephalopathy Center of Traditional Chinese Medicine Hospital of Guangdong Province.2、Patients with ischemic cerebrovascular disease belong to ischemia group,and patients with hemorrhagic cerebrovascular disease belong to bleeding group.Comparing two groups in the epidemiology,clinical manifestation,medical history,imaging features,treatment,prognosis and characteristics of TCM syndrome type distribution.3、Summarizing the TCM syndrome type distribution characteristics of adult patients with MMD,analyzing TCM pathogenesis of MMD,pathogenesis differences between ischemic MMD and hemorrhagic MMD.4、All the data using SPSS 22.0 statistical software for processing.All data adopt bilateral test statistics,and the statistical inference inspection level was set as a =0.05,and P<0.05 was thought as statistically significant differenceResults:1、There was no significant difference between ischemia and hemorrhage group in average age of onset(51.61 ± 13.793 vs 44.57±13.932,P>0.05)and gender(1.35:1 vs 1.15:1,P>0.05).2.The medical histories,smoking(30.30%vs 25.00%),hypertension(24%vs 17.86%),diabetes(18.19%vs 10.71%),are common in booth ischemia group and hemorrhage group,however,there was no significant difference between the two group(P>0.05).3、The incidence of unconsciousness(6.06%vs 35.71%,P<0.05)and headache(0%vs 28.57%,P<0.05)in ischemia group was significant lower than that in hemorrhage group,while the incidence of movement disorder of limb(45.45%vs 25.00%,P>0.05),abnormal sensation of limbs(21.21%vs 3.56%,P>0.05)and dizziness(21.21%vs 3.56%,P>0.05)is higher than that in hemorrhage group(P>0.05).4.For ischemia group,60.61%of patients were anterior circulation infarction,and 36.36%of patients were both anterior and posterior circulation infarction.83.87%of them were cortex infarction.16.13%of them were subcortical infarction.For hemorrhage group,75.00%of the patients had parenchymal hemorrhage,60.71%of the patients had intraventricular hemorrhage and 21.43%of the patients had subaraclmoid hemorrhage.In branches lesion vessels,ICA was the commonest in both group(84.85%vs 83.93%),then followed with MCA(72.73%vs 69.64%)and ACA(48.49%vs 50.00%),PCA(22.72%vs 10.71%),no statistically significant difference was observed(P>0.05).There were 7 cases of aneurysms in this study,21.43%of the cases were in bleeding group,and 6.7%of the cases were in ischemia group(P<0.05).Suzuki grade V(36.36%)and VI(36.36%vs 17.85%,P<0.05;15.15%vs 5.36%,P<0.05)in infarction group were more higher than that in hemorrhage group,while Suzuki grade Ⅲ(33.92%vs 18.18%,P<0.05)in hemorrhage group were higher than that in infarction group.5.90.9%of ischemia patients and 42.86%of hemorrhage patients received conservative treatment.In cases treated with surgery,3 ischemia patients and 4 hemorrhage patients received indirect revascularization,4 patients in hemorrhage group received intracranial aneurysm embolization,and all of the remaining hematencephalon patients were treated with ventricular drainage,clearance of intracerebral hematoma,decompressive craniectomy.6、The mRs score of patients in bleeding group was higher than that in ischemic group(2.00± 1.75 vs.1.03± 1.14,P<0.05).7、In the patients with stroke involving both collateral and meridian,"qi-deficiency and blood-stasis" is more commoner in ischemia group than that in hemorrhage group(36.36%vs 10.71%,P<0.05),while "tanre fushi and fengtans hangrao" is more commoner in hemorrhage group(28.57%vs 15.15%,P>0.05).In the patients with stroke involving zang and fu organs,"tanre neibi xinqiaoare" both commoner than other TCM syndrome in the two group(6.01%vs 17.86%,P>0.05).Concusion:1、MMD most often occur in young and middle-aged people,and there is no significant difference between ischemic MMD and hemorrhagic MMD in age and sex.2、Common clinical manifestations of adult MMD contain disorder of limbs’activity,disturbance of consciousness,sensory disturbances of limbs,headache,dizziness.Compared with the ischemia patients,patients with cerebral hemorrhage were at a higher risk of getting disturbance of consciousness and headache.3、Adult ischemic MMD located mainly in anterior circulation,and the lesions sites could change along with the progress of the illness;the most common site of hemorrhagic MMD was brain parenchyma,then were ventricle and subarachnoid space.4、Suzuki stage Ⅲ and Ⅳ overwhelmed over other stages in hemorrhagic MMD,however,in ischemic MMD,Suzuki stage V and VI are more common than other stage5、Compared with the ischemic patients with MMD,hemorrhagic MMD patients had bad prognosis.6、MMD could be belonged to scope of stroke in TCM,the occurrence and development of this disease are related to six various factors,such as wind,fire,phlegm,deficiency,qi,and blood.The pathogenesis between hemorrhagic MMD and ischemic MMD is different dramatically,patients witch hemorrhagic MMD were characterized by yang syndrome,while ischemic MMD was characterized with yin syndrome,especially the syndrom "qi-deficiency and blood-stasis".