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Título

Doença de moyamoya apresentando-se com Hemorragia Cerebral: relato de caso

RESUMO

MOYAMOYA DISEASE PRESENTING AS CEREBRAL HEMORRHAGE: CASE REPORT

Pedro Thiago Simões Ferreira, Juliana Oliveira de Almeida, João Vitor Nunes Sobreira Cruz, Allef Roberto Gomes Bezerra, Kirsten Araújo Melo, Simone de Cássia Silveira Silva, Alice Cavalcante de Almeida Lins, Bruna Acioly Leão, Nayra Roberta Sales Salvador, Patrícia Pereira Nunes.

E-mail do autor principal: pedro_thiago22@hotmail.com

Case presentation
Female, 41 years old, complained of sudden headache, vomiting and posterior neck pain two days ago, evolving with impaired level of consciousness and sphincter release. Past medical history: obesity and hypertension. Physical examination: somnolent, responsive to commands, pupils equal round and reactive to light, hemiplegia and hypoesthesia in the left lower limb, Kernig and Lasègue’s signs positive. CT and CT-angiography: newly subarachnoid hemorrhage in the supra and infratentorial cisterns; hematoma in the right thalamus and intern capsule filling all the four ventricles; diffuse parietal irregularity of arteries from carotid system, with multiples areas of stenosis in filiform flow in the distal segments of the middle and anterior cerebral arteries. Cerebral angiography: moyamoya pattern in the carotid systems.

Discussion:
The evidences of the subarachnoid hemorrhage and distal arterial irregularities from carotid system suggested vasculitis or vasospasm, needing complementation with cerebral angiography that showed stenosis of the distal supraclinoid internal carotid arteries with subocclusion/occlusion of the carotid ‘T’ and hypertrophy of the lenticulostriate arteries and of the cisternal piercing branches compatible with ‘moyamoya’ pattern.

Final comments:
Only 10 percent of the cases of MoyaMoya Disease (MMD) presents as intracerebral hemorrhage. The most often initial presenting is the ischemic stroke. In patients with cerebral hemorrhage the bleeding occurs in deep structures such as the basal ganglia, thalamus and/or the ventricular system. Cortical/subcortical bleeding is less frequent. The patient above presented cerebrovascular syndrome and images with a specific pattern compatible with the description from literature for MMD.

Palavras Chave

Doença de MoyaMoya

Área

Doença Cerebrovascular