Abstract Details

Title Appropriate Management for a Patient of Moyamoya Disease Presenting with Ischemic Stroke as an Initial Manifestation in the First Trimester of Pregnancy and Good Clinical Course: a Case Report

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P16 - Poster Session 16 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-013

Objective We aim to suggest one of appropriate managements for extremely rare case of moyamoya disease (MMD) presenting with ischemic stroke as an initial manifestation in the first trimester of pregnancy.

Background It has been reported that the prevalence of pregnancy-associated stroke was about 0.01% and MMD accounted for 10% of them. The majority occur in the between second trimester and postpartum period. This is because the changes of cardiovascular hemodynamics and coagulation mechanisms as pregnancy progresses cause development of pregnancy-associated stroke.

Design/Methods NA

Results A 27-year-old woman in the seventh week of pregnancy suffered from severe hyperemesis gravidarum from nine days before. She developed speech and gait disturbance from two days prior to admission. Her blood pressure was 108/64 mmHg and pulse rate was 86 bpm without arrhythmia. Neurological examination showed mild consciousness disturbance, motor aphasia, right hemiparesis, and right-sided hemispatial neglect. Laboratory investigations indicated hypovolemia and ketosis without abnormalities in blood coagulation and cerebrospinal fluid. Brain MRI on diffusion-weighted image showed high intensity lesions in both watershed territories between anterior and middle cerebral artery with left-sided dominancy. Brain MRA revealed severe stenosis and occlusion at the terminal portion of the bilateral internal carotid artery, compatible with MMD. We decided her to have an artificial abortion on the second day after admission because her neurological symptoms rapidly progressed and became refractory to optimal antithrombotic treatments. She recovered to independence in activities of daily living with slight motor aphasia and right hemiparesis. There has been no recurrence of ischemic stroke after bilateral superficial temporal artery to middle cerebral artery anastomosis.

Conclusions We should consider the possibility of ischemic stroke due to MMD with hyperemesis gravidarum even in the first trimester of pregnancy. It highlights that managements involving artificial abortion for patients resembling this case may be one of considerable treatments to avoid permanent disabilities.

Authors/Disclosures
Masashi Watanabe, MD (Ehime Prefectural Central Hospital) PRESENTER	Dr. Watanabe has nothing to disclose.
	No disclosure on file

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Abstract Details