Wonhyoung Park 1, Jae Sung Ahn 2, Jaewoo Chung 1, Yeongu Chung 1, Seungjoo Lee 1, Jung Cheol Park 1, Byung Duk Kwun 1
Abstract
Background: We reviewed our clinical experience of patients with moyamoya disease (MMD) who gave birth and assessed characteristics of those experiencing neurologic deterioration.
Methods: The patients were classified into patients diagnosed with MMD during pregnancy and puerperium (group 1) and those diagnosed before pregnancy (group 2). We retrospectively reviewed patient characteristics, MMD treatment, neurologic symptoms before and during pregnancy and/after puerperium, obstetrical history, and delivery type in groups 1 and 2.
Results: Group 1 included 2 patients with deterioration of pre-existing transient ischemic attacks (TIAs) and acute cerebral infarction and 1 patient with seizures and newly developed TIAs during pregnancy and/or puerperium. Group 2 included 20 patients with 23 pregnancies. In group 2, 4 patients had deterioration of TIAs during pregnancy and puerperium. There were significant differences between the cases without neurologic deterioration and with deterioration in group 2 (TIAs ≥10 before pregnancy, 0% vs. 75%, P = 0.002; severely reduced regional cerebrovascular reserve on single-photon emission computed tomography, 10.5% vs. 100%, P = 0.002; and surgical revascularization before pregnancy, 75% vs. 15.8%, P = 0.04). In groups 1 and 2, 6 of the 7 cases in which TIAs occurred or worsened during pregnancy or puerperium recovered to prepregnancy TIA levels after puerperium.
Conclusions: Patients with severely reduced regional cerebrovascular reserve on single-photon emission computed tomography and frequent TIAs before pregnancy may experience neurologic deterioration during pregnancy, delivery, and puerperium. Surgical revascularization before pregnancy may decrease neurologic deterioration during these periods.
Keywords: Moyamoya disease; Parturition; Pregnancy; Puerperium; Stroke.
Figure 1. The “10-bend” color scale for displaying single-photon emission computed tomography (SPECT). Normal cerebellar activity was assigned as the reference value, and values indicating >90% perfusion are shown in red. A “mild” grade indicates a 10%–20% reduction in regional cerebrovascular reserve (rCVR) after the administration of acetazolamide, which is visible as a decrease of one color range from Basal brain perfusion SPECT (basal-SPECT). A “severe” grade indicates a >20% reduction in rCVR after the administration of acetazolamide, which is visible as a decrease of at least 2 color ranges. ACZ-SPECT, Acetazolamide stress brain perfusion single-photon emission computed tomography.
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