Symptoms Do Not Predict White Matter Injury in the Watershed Regions in Children with Moyamoya.

Autor: Ahtam B; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA., Meadows J; Department of Neurology, Boston Children's Hospital, Boston, MA., Berto LF; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA., Lildharrie C; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA., Solti M; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA., Doo JM; Department of Neurology, Boston Children's Hospital, Boston, MA., Feldman HA; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA., Vyas R; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA., Zhang F; Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA., O'Donnell LJ; Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA., Rathi Y; Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA., Stout J; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Neurosurgery, Boston Children's Hospital, Boston, MA., Smith ER; Harvard Medical School, Boston, MA; Department of Neurosurgery, Boston Children's Hospital, Boston, MA., Orbach DB; Harvard Medical School, Boston, MA; Department of Radiology, Boston Children's Hospital, Boston, MA., See AP; Harvard Medical School, Boston, MA; Department of Neurosurgery, Boston Children's Hospital, Boston, MA; Department of Radiology, Boston Children's Hospital, Boston, MA., Grant PE; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Radiology, Boston Children's Hospital, Boston, MA., Lehman LL; Harvard Medical School, Boston, MA; Department of Neurology, Boston Children's Hospital, Boston, MA. Electronic address: Laura.Lehman@childrens.harvard.edu.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2025 Jan; Vol. 276, pp. 114372. Date of Electronic Publication: 2024 Oct 18.
DOI: 10.1016/j.jpeds.2024.114372
Abstrakt: Objective: To assess whether white matter injuries differ in symptomatic vs asymptomatic moyamoya-affected hemispheres using diffusion magnetic resonance imaging since there is controversy regarding when or if to revascularize children with asymptomatic moyamoya.
Study Design: We conducted a cross-sectional study of children with moyamoya who underwent diffusion magnetic resonance imaging before revascularization surgery as well as controls without moyamoya. We measured the fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity of white matter tracts in the watershed regions. Moyamoya-affected hemispheres were included if they did not have any visible stroke or infarct. Moyamoya-affected hemispheres were labeled "symptomatic" if transient ischemic attack, seizure, or movement disorder were localizable to that hemisphere, or if the child experienced headaches. Moyamoya-affected hemispheres were "asymptomatic" if the child did not have symptoms attributable to that hemisphere. Asymptomatic and symptomatic hemispheres were compared with each other and control children using ANOVA.
Results: We included 17 children with moyamoya with 26 moyamoya-affected hemispheres and 27 control children. Compared with controls, mean diffusivity, radial diffusivity, and axial diffusivity were greater in both symptomatic and asymptomatic moyamoya-affected hemispheres but were not significantly different from each other.
Conclusions: Children with moyamoya without stroke or silent infarct have unrecognized white matter injury that is similar in both symptomatic and asymptomatic moyamoya-affected hemispheres, suggesting that symptoms do not accurately reflect moyamoya severity.
Competing Interests: Declaration of Competing Interest This work was supported by a Boston Children's Hospital Office of Faculty Development/Basic & Clinical Translational Research Executive Committees Faculty Career Development Fellowship (L.L.), Thrasher Early Investigator Award (J.S.). The authors declare no conflicts of interest.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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