Background
Adult moyamoya disease (MMD) is known to have high incidence of cerebral microbleeds
(cMBs); however, the clinical significance still remains unclear. We investigated
the frequency of cMBs in a large number of patients and analyzed the patterns of MB
distribution in association with the location of the hematoma and moyamoya vessels.
Methods
We studied 259 consecutive patients with MMD using prospectively collected database.
One hundred ninety-one patients were eligible for the present study, and image analysis
was performed retrospectively. The presence of cMBs and remains of hemorrhage were
determined using gradient-echo T2*-weighted sequence (1.5 T). The development of moyamoya
vessels was assessed on source images of time-of-flight magnetic resonance angiography.
The analysis consists of descriptive assessment of the spatial relationship between
cMB, remains of hemorrhage, and moyamoya vessels. Statistical analysis was performed
to calculate relative risk ratio in the presence of cMBs in relation to the remains
of hemorrhage (macrohematoma), age of onset, and the presence of concomitant moyamoya
vessels.
Results
Thirty MBs were observed in 20 adult MMD patients (16.9%). MBs were located predominantly
in the periventricular white matter (63.3%) followed by the basal ganglia/thalami
(20%). Comparing the patients with cMBs from those without, hematoma was more frequently
observed in patients with cMBs (odds ratio [OR] 4.29; 95% confidence interval [CI]
1.58-11.62; P = .0062). Patients with adult onset was more likely to demonstrate cMBs (14.4%) compared
with the patients with pediatric onset (4.1%) (OR 3.93; 95% CI 1.11-13.91). Moyamoya
vessels appeared in the lateral part of the trigon, and the periventricular white
matter was significantly associated with the presence of cMBs (lateral part of the
trigon; OR 3.29 [1.59-6.82], P = .0019, periventricle of the body of lateral ventricle; OR 2.40 [1.20-4.79], P = .0214, respectively). cMBs accompanied concomitant arteries in 23 (76.7%) lesions.
The subependymal–leptomeningeal artery anastomosis was the most common pattern (n = 20,
66.7%).
Conclusions
Spatial relationship was demonstrated between the moyamoya vessels and perivascular
hemosiderin deposition particularly around the subependymal–leptomeningeal anastomosis,
suggesting the mechanism for the development of cMBs in MMD. Present study further
supports previous findings that cMBs potentially serve as a marker for the bleeding-prone
microangiopathy in MMD. The significance of the present study lies in selecting optimal
surgical candidate for preventing future hemorrhage by the presence of the cMBs, whereas
current surgical indication relying on the degree of ischemia frequently fails to
detect patients with future hemorrhage.
Key Words
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Article info
Publication history
Published online: February 19, 2014
Accepted:
December 3,
2013
Received in revised form:
October 10,
2013
Received:
July 22,
2013
Footnotes
Funding: No grants or funding sources are pertinent to this article.
Conflicts of interest: None.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.12.007
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
