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Stroke, Vol 23, 1360-1363, Copyright © 1992 by American Heart Association

ARTICLES

Caudate hemorrhage with moyamoya-like vasculopathy from atherosclerotic disease

W Steinke, TK Tatemichi, JP Mohr, A Massaro, I Prohovnik and RA Solomon
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York.

BACKGROUND AND PURPOSE: Caudate hemorrhage usually results from hypertension, rupture of arteriovenous malformation or aneurysm, or rarely, moyamoya disease. Moyamoya-like changes related to severe atherosclerotic occlusive disease, usually causing ischemic stroke, have been reported. CASE DESCRIPTION: A 51-year-old normotensive patient was admitted with headache due to a left caudate hematoma with ventricular extension. There was a history of smoking, leg claudication, elevated cholesterol, and coronary artery disease. Angiography demonstrated complete extracranial carotid occlusion on the left and atherosclerotic stenosis at the bifurcation on the right, with supraophthalmic occlusion distally. At the base of the brain, bilateral moyamoya-like vessels, presumed to be secondary to atherosclerotic occlusion, were evident, but neither aneurysm nor arteriovenous malformation was present. Cerebral blood flow and transcranial Doppler studies indicated severely impaired cerebral perfusion that improved after bilateral extracranial-to-intracranial bypass surgery. CONCLUSIONS: Atherosclerotic occlusive carotid disease with moyamoya- like changes may be a rare cause of caudate hemorrhage. A decrease in moyamoya vessels with bypass surgery may reduce the risk of recurrent hemorrhage.

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				D. Chiu, P. Shedden, P. Bratina, and J. C. Grotta Clinical Features of Moyamoya Disease in the United States Stroke, July 1, 1998; 29(7): 1347 - 1351. [Abstract] [Full Text] [PDF]