Moyamoya disease in pregnancy: a case series and review of management options.

BACKGROUND

Pregnancy has a potentially deleterious affect on moyamoya disease (MMD), a cerebrovascular condition characterized by spontaneous occlusion of the distal internal carotid arteries resulting in the neoangiogenesis of fragile collateral blood vessels. The disease renders patients susceptible to both hemorrhagic and ischemic stroke.

METHODS

A 16-year (1995-2010) chart review was performed at the Kapi'olani Medical Center for Women and Children and the Queen's Medical Center, the two largest birthing centers in Hawai'i.

RESULTS

The authors report on three women with MMD who had the revascularization surgery prior to their first pregnancy and experienced successful pregnancy outcomes without the MMD symptoms. Two of these were managed with antiplatelet agents, one with calcium channel blockers, and two with magnesium sulphate in the perioperative period.

CONCLUSION

The authors' cases demonstrate different medical therapies, which may be of benefit for MMD with and without revascularization surgery during pregnancy.