22. European Stroke Conference 138 Interesting and challenging cases Reversible Moyamoya Syndrome with Tuberculous Meningitis H.K. Park1, K.I. Yang2, D.S. Jeong3, H.K. Oh4, S.J. Kim5 Department of Neurology, College of Medicine, Soonchunhyang University Cheonan Hospi-tal, Cheonan, SOUTH KOREA1, Department of Neurology, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, SOUTH KOREA2, Department of Neurology, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, SOUTH KOREA3, Depart-ment of Neurology, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, SOUTH KOREA4, Department of Neurology, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, SOUTH KOREA5 Background : Tuberculous meningoencephalitis causes various vascular complications including an accompanying moyamoya syndrome , which has been rarely reported. In this report, we have de-scribed the reversible moyamoya syndrome with tuberculous meningitis. Method(Case) : A 50-year old man admitted to our hospital in a stuporous mental state with right hemiplegia. Chest X-rays showed widespread bilateral consolidation with a cavitary nodule, sug-gesting miliary tuberculosis. Tbc meningitis was diagnosed in CSF study. Brain MRI and MRA showed occlusion of the distal internal carotid artery and multiple ischemic changes, which were consistent with moyamoya syndrome. Result : After antituberculous treatment, he visited our hospital 6 months later and follow-up MRI and MRA was performed. MRA finding showed recanalization of previous occluded vessels. Conclusions : A few cases of tuberculous meningitis associated with moyamoya syndrome have been reported recently. But as in our case, major cerebral infarction with reversible moyamoya syn-drome was vary interesting case. We performed follow-up MRA imaging and reversibility of cere-bral vessel was confirmed. 354 © 2013 S. Karger AG, Basel Scientific Programme 139 Interesting and challenging cases Severe progressive occlusive arteriopathy in a 2-year old girl: moyamoya disease or primary central nervous system vasculitis? V. Duranovic1, I. Dakovic2, L. Lujic3, J. Marjanovic4, T. Grmoja5, D. Ozretic6, J. Lenicek Krleza7, V. Mejaski Bosnjak8 Children’s Hospital Zagreb, Department of Neuropediatrics, University of Zagreb, Medical School, Zagreb, Croatia, Zagreb, CROATIA1, Children’s Hospital Zagreb, Department of Neuro-pediatrics, University of Zagreb, Medical School, Zagreb, Croatia, Zagreb, CROATIA2, Children’s Hospital Zagreb, Department of Neuropediatrics, University of Zagreb, Medical School, Zagreb, Croatia, Zagreb, CROATIA3, Children’s Hospital Zagreb, Department of Pediatric Radiology, Uni-versity of Zagreb, Medical School, Zagreb, Croatia, Zagreb, CROATIA4, Children’s Hospital Za-greb, Department of Pediatric Radiology, University of Zagreb, Medical School, Zagreb, Croatia, Zagreb, CROATIA5, University Hospital Centre Zagreb, Department of Radiology, University of Zagreb, Medical School, Zagreb, Croatia, Zagreb, CROATIA6, Children’s Hospital Zagreb, De-partments of Laboratory Diagnostics, University of Zagreb School of Medicine, Zagreb, Croatia, Zagreb, CROATIA7, Children’s Hospital Zagreb, Department of Neuropediatrics, University of Za-greb, Medical School, Zagreb, Croatia, Zagreb, CROATIA8 Background: Moyamoya disease (MMD) and primary central nervous system vasculitis (PCNSV) are rare vascular disorders in children. Both can cause ischemic stroke with severe consequences. Clinical presentation can be very similar, but differentiation is important due to different treatment. Methods and results: Patient’s development was normal until 13 months when she suffered general-ized seizures. At 21 months she started to experience stroke-like episodes of transient hemiparesis with slurred speech, lasting 3-4 hours. First MRI was normal, but MRI four months later showed multiple hyperintensive lesions, resembling acute ischemia with tortuotic and hyperemic vessels su-spective of vasculitis. Detailed assessment excluded coagulopathies, metabolic, neurocutaneous, au-toimmune and cardiac diseases and infections. Transcranial color-coded duplex sonography (TCCS) showed pathological spectrum of frequencies and high flow velocities in middle and posterior cere-bral arteries (MCA/PCA). Under assumption of PCNSV corticoid therapy was induced. New relapse occurred after 1,5 month and control MRI was worsened. TCCS showed no detectable flow in both MCA, so cyclophosphamide was added. After subsequent relapse, one cycle of plasmapheresys was performed without improvement. After DSA diagnose of atypicall MMD with possible inflammato-ry cause of occlusion antiplatelets were induced. Last MRI showed new large areas of infarction in almost whole left and residuals of previous infarctions in right hemisphere. Girl’s mother suffers of recidivant facioparesis, has normal MRA and one small gliosys periventricularly. Mother’s mother died of SLE, she had multiple stenoses of renal arteries, as well as mother’s sister, who also suffers of internal carotid artery stenosis with recidivant TIAs and CVI. Conclusion: We are still in dilemma of MMD, PCNSV or other cause of severe progressive occlu-sive vasculopathy in girl. Surgical treatment - multiple cerebral revascularisation is scheduled.
Karger_ESC London_2013
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