Bilateral STA-MCA bypass for Moyamoya angiopathy associated with severe erythrodermic psoriasis.

Autor: Jha R; Harvard Medical School, Boston, MA, United States. Electronic address: rjha@hms.harvard.edu., Kappel AD; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: akappel@bwh.harvard.edu., Feroze AH; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: aferoze@bwh.harvard.edu., Essayed W; Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, MA, United States. Electronic address: walidessayed@gmail.com., Patel NJ; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: npatel40@bwh.harvard.edu.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2024 Nov; Vol. 33 (11), pp. 107997. Date of Electronic Publication: 2024 Sep 05.
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107997
Abstrakt: Objective: We report on the uncommon association between severe erythrodermic psoriasis and moyamoya angiopathy (MMA), a progressive cerebrovascular disorder characterized by steno-occlusive changes in the circle of Willis. Concomitant moyamoya and severe erythrodermic psoriasis is a rare pathology, with unknown pathogenesis. MMA with severe erythrodermic psoriasis, even in the setting of stroke, is often managed with non-curative medical intervention alone, due to concerns for surgical instability. Here we show with appropriate surgical consideration and medical management, patients can undergo curative surgical management, and remain stroke free during follow-up.
Case Report: The patient, a 52-year-old female, with refractory psoriasis, presented with neurological deficits, leading to the diagnosis of bilateral moyamoya arteriopathy. Patients with these co-existing conditions have historically only been medially managed, due to concerns for surgical instability and inadequate candidacy. A comprehensive stroke workup revealed severe stenosis in the internal carotid arteries. A two-stage surgical revascularization, including right superficial temporal artery-middle cerebral artery (STA-MCA) bypass and subsequent left STA-MCA bypass, was successfully performed. Postoperatively, the patient experienced a severe psoriasis flare, requiring meticulous management to ensure post-operative surgical stability.
Conclusions: With appropriate medical and surgical management, the patient was amenable for curative surgical intervention. The successful surgical intervention, following medical optimization of psoriasis, demonstrated efficacy in preventing future cerebral ischemia events in this challenging patient.
Competing Interests: Declaration of competing interest No competing interests to declare.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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