Key result
A 39-year-old woman with pre-existing middle cerebral artery stenosis developed progressive moyamoya disease and cerebral infarction during the early postpartum period.
Case Report (n=1)
No
Moyamoya disease can newly develop or progress during pregnancy and the puerperium, highlighting a potential pitfall in managing pregnant patients with prior cerebral artery stenosis.
May warrant vigilance for moyamoya progression in postpartum patients with cerebral stenosis; hypothesis-generating case report requiring prospective confirmation.
Progressive moyamoya disease in pregnancy and puerperium has not been reported previously. Here, we present a 39-year-old woman who had been found to have moderate stenosis of right middle cerebral artery (MCA) 4 years prior to her pregnancy, finally suffering minor completed stroke due to progressive moyamoya disease at the early postpartum period. Three days after cesarean section without any complication, she developed cerebral infraction at right hemisphere, when magnetic resonance angiography indicated apparent progression of the proximal MCA stenosis. Catheter angiography demonstrated nearly occlusion of the right terminal internal carotid artery (ICA) and the development of an abnormal vascular network at the base of the brain as well as MCA stenosis, indicating a definitive diagnosis of moyamoya disease with unilateral involvement. The patient underwent superficial temporal artery-middle cerebral artery anastomosis 1 month after the onset of stroke, and she did not manifest as further neurological events during the follow-up period of 2 years. Moyamoya disease could newly develop in pregnancy and puerperium, which should be noted as a pitfall of the management of moyamoya disease with pregnancy.
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Akamatsu et al. (2014) conducted a case report in Moyamoya disease (n=1). Pregnancy and puerperium was evaluated on Development of progressive moyamoya disease and cerebral infarction. A 39-year-old woman with pre-existing middle cerebral artery stenosis developed progressive moyamoya disease and cerebral infarction during the early postpartum period.
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