Stroke is often referred to as a “brain attack” and can occur in all ages. An injury to the brain, stroke is caused by insufficient blood flow in the brain–usually by a blood clot or a direct bleed into the brain itself.
Strokes kill more women than men: twice as many than by breast cancer every year. So women need to know not only about the risk factors and warning signs of stroke, but also Moyamoya disease–a little-known cause of stroke that is more common in women and often goes misdiagnosed for years.
Moyamoya disease was originally diagnosed in Japanese patients. Moyamoya is the Japanese word for “puff of smoke.” It is a rare brain artery disorder caused by the slowly progressive narrowing and blockage of the large branches of the internal carotid artery at the base of the brain. To feed the brain tissue that is starving for blood flow, the body forms a network of dilated and weakened blood vessels that resembles a “puff of smoke” on angiography.
While this new blood vessel network allows blood to continue to flow to the brain, it is weak. Patients with Moyamoya disease may experience signs of stroke due to insufficient blood flow, termed an ischemic stroke, or to a bursting of these new vessels, called hemorrhagic stroke.
Treatments Can Ward Off Stroke
Fortunately, there are effective Moyamoya treatments available if the disease is diagnosed in time. The treatments are designed to bypass the blocked arteries at the base of the brain and provide sufficient blood flow to prevent ischemic stroke. These bypasses also take the strain off of the “puff of smoke” blood vessels and can decrease the chance of bleeding.
There are two types of bypass:
The direct bypass immediately restores blood flow to the starved arteries by directly connecting an artery in the scalp to an artery in the brain.
The indirect bypass (called an EDAS procedure) involves laying the scalp artery on the brain itself and relies on the starving brain to stimulate new blood vessel growth from this artery, which can take months.
A vascular neurosurgeon can perform the procedures alone or in combination, based on blood flow tests and the patient’s individual needs.
The bottom line is that the keys to successful stroke treatment remain time and prevention. The earlier stroke treatment is initiated, the higher the likelihood of a good outcome because “time is brain.” Smoking cessation and blood pressure control are vitally important, along with an active lifestyle and a healthy diet.
This post was written by Jeffrey Katz, MD, chief of vascular neurology at North Shore University Hospital.
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