J Korean Neurosurg Soc.  2013 Nov;54(5):411-414. 10.3340/jkns.2013.54.5.411.

Rapid Progression of Cerebral Infarction after Intraventricular Hemorrhage in Adult Moyamoya Disease

• Matsumoto
• Yoshida Y

• KMID: 2138357
• DOI: http://doi.org/10.3340/jkns.2013.54.5.411

Abstract

The authors present a rare case of adult moyamoya disease in which a patient experienced rapid progression of cerebral infarction after intraventricular hemorrhage (IVH). A healthy 39-year-old woman was admitted to our hospital with sudden headache, a decreased level of consciousness and mild tetraparesis. Initial magnetic resonance imaging revealed small cerebral infarction and IVH. Although the patient underwent conservative therapy including hypervolemia, hemodilution, keeping moderate hypertension and administration of a free radical scavenger, she showed a fulminant clinical course of cerebral infarction. The authors discuss the possible pathophysiology and suggest the treatment for such cases.

Keyword

Moyamoya disease; Cerebral infarction; Intraventricular hemorrhage

MeSH Terms

Adult*
Cerebral Infarction*
Consciousness
Female
Headache
Hemodilution
Hemorrhage*
Humans
Hypertension
Magnetic Resonance Imaging
Moyamoya Disease*

Figure

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  Fig. 1 Magnetic resonance (MR) imaging obtained on admission. Diffusion weighted imaging reveals intraventricular hemorrhage and acute cerebral infarction in bilateral frontal lobes (A, B and C). MR angiography reveals bilateral occlusion at the terminal of the internal carotid artery, indicating moyamoya disease (D). Fluid-attenuated inversion recovery imaging reveals asymptomatic, old cerebral infarction in the left frontal lobe (E). T2-star-weighted imaging does not reveal low intensity (F).

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  Fig. 2 Diffusion weighted imaging obtained on the second hospital day showing expansion of cerebral infarction in the left cerebral hemisphere without progression of IVH.

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  Fig. 3 Diffusion weighted imaging obtained on the 14th hospital day showing expansion of cerebral infarction in the bilateral cerebral hemispheres without ventriculomegaly.

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