De Novo Cerebral Microbleeds and Cognitive Decline in Cerebral Hyperperfusion After Direct Revascularization for Adult Moyamoya Disease
Autor: | Shunrou Fujiwara, Kazumasa Dobashi, Yasukazu Katakura, Kazunori Terasaki, Kohei Chida, Kuniaki Ogasawara, Kenji Yoshida, Kazuto Kimura, Masakazu Kobayashi, Yoshitaka Kubo |
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Rok vydání: | 2021 |
Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Perfusion scanning Revascularization Postoperative Complications Internal medicine medicine Humans Cognitive Dysfunction Moyamoya disease Prospective Studies Cognitive decline Prospective cohort study Cerebral Hemorrhage medicine.diagnostic_test Revascularization surgery Cerebral Revascularization business.industry Rehabilitation Magnetic resonance imaging medicine.disease Cerebrovascular Circulation Cardiology Surgery Neurology (clinical) Moyamoya Disease Cardiology and Cardiovascular Medicine business Emission computed tomography |
Zdroj: | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 31(1) |
ISSN: | 1532-8511 |
Popis: | Objectives Adult patients with moyamoya disease (MMD) occasionally develop cognitive decline due to cerebral hyperperfusion following direct revascularization surgery. However, how the hyperperfusion phenomenon contributes to declines in cognitive function remains unclear. The present supplementary analysis of a prospective study aimed to determine whether cerebral hyperperfusion following direct revascularization surgery for adult MMD with ischemic presentation and misery perfusion leads to development of de novo cerebral microbleeds (CMBs) and whether postoperative cognitive decline is related to these CMBs. Materials and Methods In total, 32 patients who underwent direct revascularization surgery also underwent T2*-weighted magnetic resonance imaging (T2*WI) and neuropsychological testing before and 2 months after surgery. Development of cerebral hyperperfusion and hyperperfusion syndrome following surgery was defined based on brain perfusion single-photon emission computed tomography (SPECT) findings and clinical symptoms. Results Cerebral hyperperfusion on brain perfusion SPECT (95% confidence interval [CI], 1.1–10.8; p = 0.0175) or cerebral hyperperfusion syndrome (95%CI, 1.3–15.3; p = 0.0029) was significantly associated with postoperatively increased CMBs on T2*WI. Postoperatively increased CMBs were significantly associated with postoperative cognitive decline (95%CI, 1.8–20.4, p = 0.0041). For patients with cerebral hyperperfusion on brain perfusion SPECT, the incidence of postoperative cognitive decline was significantly greater in patients with than in those without postoperatively increased CMBs (p = 0.0294). Conclusions Cerebral hyperperfusion following direct revascularization surgery for adult MMD with ischemic presentation and misery perfusion contributes to the development of de novo CMBs and postoperative cognitive decline is related to these CMBs. |
Databáze: | OpenAIRE |
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