Moyamoya Disease and Pregnancy: Case Report and Review of the Literature

Moyamoya Disease and Pregnancy: Case Report and Review of the Literature AbstractOBJECTIVE AND IMPORTANCE:Many female patients with moyamoya disease are of childbearing years, including those who were diagnosed before entering their childbearing years. However, there have been no extensive reviews of the management of pregnancy and delivery in association with moyamoya disease. The purpose of this report is to describe the case of a patient with moyamoya disease complicated by pregnancy and to review the literature on other such cases.CLINICAL PRESENTATION AND INTERVENTION:We report a 23-year-old primipara with moyamoya disease who delivered uneventfully by cesarean section under spinal anesthesia at 38 weeks of gestation. In the literature, 30 cases were reported of patients who had been diagnosed with moyamoya disease before pregnancy and delivery, and 23 patients who were symptomatic and were diagnosed for the first time with moyamoya disease in association with pregnancy.CONCLUSION:There is no evidence that pregnancy increases the risk of cerebrovascular accident or that bypass surgery decreases its risk. Poor prognosis of the patient or the newborn is mostly caused by cerebral hemorrhage and not by cerebral ischemia. It is important to control blood pressure and especially to avoid toxemia during pregnancy. Either cesarean section or vaginal delivery can be accomplished safely. Any anesthetic method can be used, provided special attention is given to avoiding hypocapnia, hypotension, and hypertension. Oral contraceptives should be avoided. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Moyamoya Disease and Pregnancy: Case Report and Review of the Literature

Moyamoya Disease and Pregnancy: Case Report and Review of the Literature

360 Komiyama et al. moya disease may be divided into two Moyamoya Disease and Pregnancy: Case categories in terms of the timing of clinical manifestation: those for whom diagnosis Report and Review of the Literature was made before the patient became pregnant (the patients known to have moyamoya disease) and those for whom diagnosis was made for the first time Masaki Komiyama, M.D., Toshihiro Yasui, M.D., while the patient was pregnant or during Shouhei Kitano, M.D., Hiroaki Sakamoto, M.D., puerperium (the patients newly diag­ Ken Fujitani, M.D., Shigeki Matsuo, M.D. nosed with moyamoya disease). In addi­ tion to participating in the clinical man­ O sa k a C ity General H ospital, Departments of Neurosurgery (MK, TY), Pediatric Neurosurgery (SK, HS, KF), and Obstetrics and G y n e c o lo g y (SM), O saka , Japan agement of the patients in these two categories, neurosurgeons must be pre­ pared to provide sufficient information regarding the risks associated with preg­ O B JE C T IV E A N D IM P O R T A N C E: Many female patients with moyamoya nancy to nonp>regnant patients who are disease are of childbearing years, including those who were diagnosed known to have moyamoya disease and before entering their childbearing years. However, there have been no who want to have a baby. Although there extensive reviews of the management of pregnancy and delivery in asso­ are case reports of p>regnant patients ciation with moyamoya disease. The purpose of this report is to describe newly diagnosed with moyamoya disease the case of a patient with moyamoya disease complicated by pregnancy who present, in most cases, with intracra­ and to review the literature on other such cases. nial hemorrhage and of delivery by pa­ C L IN IC A L P R ESEN TA TIO N A N D IN T E R V E N T IO N : We report a 23-year-old tients known to have moyamoya disease, there have been no extensive reviews of primipara with moyamoya disease who delivered uneventfully...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199808000-00114
Publisher site
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Abstract

AbstractOBJECTIVE AND IMPORTANCE:Many female patients with moyamoya disease are of childbearing years, including those who were diagnosed before entering their childbearing years. However, there have been no extensive reviews of the management of pregnancy and delivery in association with moyamoya disease. The purpose of this report is to describe the case of a patient with moyamoya disease complicated by pregnancy and to review the literature on other such cases.CLINICAL PRESENTATION AND INTERVENTION:We report a 23-year-old primipara with moyamoya disease who delivered uneventfully by cesarean section under spinal anesthesia at 38 weeks of gestation. In the literature, 30 cases were reported of patients who had been diagnosed with moyamoya disease before pregnancy and delivery, and 23 patients who were symptomatic and were diagnosed for the first time with moyamoya disease in association with pregnancy.CONCLUSION:There is no evidence that pregnancy increases the risk of cerebrovascular accident or that bypass surgery decreases its risk. Poor prognosis of the patient or the newborn is mostly caused by cerebral hemorrhage and not by cerebral ischemia. It is important to control blood pressure and especially to avoid toxemia during pregnancy. Either cesarean section or vaginal delivery can be accomplished safely. Any anesthetic method can be used, provided special attention is given to avoiding hypocapnia, hypotension, and hypertension. Oral contraceptives should be avoided.

Journal

NeurosurgeryOxford University Press

Published: Aug 1, 1998

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