Moyamoya disease associated with antiphospholipid syndrome

Öz

Moyamoya (MMD) is a disease that often involves the vascular structures of anterior cerebral circulation, par­ticularly the proximal segments of anterior and middle cerebral arteries. The etiology of the disease is unknown. MMD often presents with cerebral ischemia and rarely with cerebral hemorrhage. The pathology is termed Moy­amoya syndrome (MMS) when the pathological cerebral angiography findings are accompanied by meningitis, neurofibromatosis, neoplasm, Down syndrome or poly­cystic kidney disease. Autoimmune diseases including Graves\' disease, Behcet\'s disease and antiphospholipid syndrome might also lead to the development of MMS. In this manuscript, we presented an interesting case of MMD associated with antiphospholipid syndrome, which is quite a rare cause of acute cerebral infarction in child­hood.

Anahtar Kelimeler

• Moyamoya, antiphospholipid syndrome, hemiparesis, convulsion

Moyamoya hastalığı ve antifosfolipid sendrom birlikteliği

Öz

Moyamoya hastalığı (MMH) çoğunlukla ön serebral do­laşıma ait vasküler yapıları özellikle de ön ve orta sereb­ral arterlerin proksimal segmentlerini tutan bir hastalıktır. Etiyolojisi net olarak bilinmemektedir. Hastalık sıklıkla serebral iskemi, nadiren de serebral hemoraji ile ortaya çıkmaktadır. Serebral anjiografideki patolojik bulguların menenjit, nörofibromatozis, neoplazmlar, Down sendro­mu ve polikistik böbrek hastalığı gibi durumlarla bir arada bulunması halinde Moyamoya sendromu (MMS) olarak isimlendirilmektedir. Graves hastalığı, Behçet hastalığı ve Antifosfolipid sendrom (AFS) gibi otoimmün hastalıklar da MS gelişmesine neden olabilmektedirler. Kliniğimizde An­tifosfolipid sendrom ile beraber MMS tanısı alan ve çocuk­luk çağı akut serebral infarkt nedenleri arasında oldukça ender görülen bu hastalık ilginç bulunarak sunuldu.

Anahtar Kelimeler

• Moyamoya, antifosfolipid sendrom, hemiparezi, konvülzyon

Kaynakça

1. Suzuki J, Kodama N. Moyamoya disease: A review. Stroke 1983;14(1):104-9.
2. Golasakkal JA. Moyamoya disease: a review. Neurol India 2002;50(1):6-10.
3. Horn P, Pfister S, Bueltmann E, Vajkoczy P, Schmiedek P. Moyamoya-like vasculopathy (moyamoya syndrome) in children. Childs Nerv Syst 2004;20(6):382-91.
4. Levine JS, Branch DW, Rauch J. The antiphospholipid syn- drome. N Engl J med 2002; 346(10):752-63.
5. Kaul M, Erkan D, Sammaritano L, Lockshin MD. Assesment of the 2006 revised antiphospholipid syndrome classifica- tion criteria. Ann Rheum Dis 2007;66(7):927-30.
6. Shetty-Ava N, Alva S. Familial Moyamoya disease in cauca- sians. Pediatr Neurol 2000;23(5):445-7.
7. Malek AM, Connors S, Robertson RL. Elevation of cerebro- spinal fluid levels of basic fibroblast growth factor in Moy- amoya and central system disorders. Pediatr Neurosurg 1997;27(4):182-9.
8. Buller HR, Agnelli G, Hull RD. Antithrombotic therapy for venous thromboembolic disease. The seventh ACCP con- ference on antithrombotic and thrombolytic therapy. Chest 2004;126 (3):401-28

9. The WARSS, APASS, PICSS, HAS and GENESIS study groups. The feasibility of a collaborative double-blind study using an anticoagulant. Cerebrovasc Dis 1997; (9)7:100- 12.
10. Yamauchi T, Tada M, Houkin K, et al. Linkage of familial moyamoya disease (spontaneous occlusion of the circle of Willis) to chromosome 17q25. Stroke 2000; 31(4):930-5.
11. Kraemer M, Heienbrok W, Berlit P. Moyamoya Disease in Europeans. Stroke 2008;39(12):3193-200.
12. Hallemeier CL, Rich KM, Grubb RL, et.al. Clinical features and outcome in North American adults with moyamoya phenomenon. Stroke 2006;37(6):1490-6.
13. Tsuchiya K, Inaoka S, Mizutani Y, Hachiya J. Echo- planar perfusion MR of Moyamoya disease. AJNR 1998;19(2):211-6.
14. Goda M, Isono M, Ishii K, Kamida T, Abe T, Kobayashi H: Long-term effects of indirect bypass surgery on collateral vessel formation in pediatric moyamoya disease. Journal of neurosurgery 2004;100(2):156-62.
15. Kim HY, Chung CS, Lee J, Han DH, Lee KH. Hyperven- tilation-induced limb shaking TIA in Moyamoya disease. Neurology 2003;60(1): 137-39.