Document Detail


Prevention of secondary ischemic events by superficial temporal artery-middle cerebral artery bypass surgery after tuberculosis-induced vasculopathy in a 5-year-old child.
MedLine Citation:
PMID:  20593990     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Tuberculosis-related vasculopathy and resulting ischemic events are a common finding after tuberculous meningitis (TBM) in children. The authors report on a case of recurring ischemic episodes that were refractory to repetitive endovascular procedures (transluminal angioplasty, stent insertion, in-stent vessel dilation). After failure of endovascular treatment, extracranial-intracranial (EC-IC) bypass surgery was performed to prevent further ischemia. This 5-year-old girl presented with a series of ischemic events in the left middle cerebral artery (MCA) territory 12 months after her presentation with TBM. Angiography studies showed a 50% lumen reduction of the left MCA. After failure of antithrombocyte aggregation and repeated endovascular procedures to prevent new ischemia, EC-IC bypass surgery was performed. The left superficial temporal artery-MCA bypass was found to be capable of preventing new ischemic events in the 21-month follow-up period, despite a near-total MCA occlusion on follow-up conventional and MR angiography studies. Bypass surgery seems to be a reliable tool to augment cerebral blood flow in tuberculosis-related stenoocclusive changes of cerebral vasculature after the failure of endovascular procedures.
Authors:
Martin Misch; Ulrich-Wilhelm Thomale; Rolf Keitzer; Peter Vajkoczy
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  6     ISSN:  1933-0715     ISO Abbreviation:  J Neurosurg Pediatr     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-02     Completed Date:  2010-07-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  69-72     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Charité Campus Virchow, Medical University of Berlin, Berlin, Germany. martin.misch@charite.de
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon
Antitubercular Agents / therapeutic use*
Brain Ischemia / diagnosis,  etiology,  prevention & control*
Cerebral Angiography
Cerebral Revascularization*
Child, Preschool
Combined Modality Therapy
Cooperative Behavior
Female
Humans
Infarction, Middle Cerebral Artery / diagnosis,  prevention & control
Interdisciplinary Communication
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Patient Care Team
Platelet Aggregation Inhibitors / therapeutic use
Postoperative Complications / diagnosis,  etiology,  prevention & control*
Recurrence / prevention & control
Stents
Tuberculoma, Intracranial / drug therapy,  surgery*
Tuberculosis, Meningeal / surgery*
Ventriculoperitoneal Shunt*
Chemical
Reg. No./Substance:
0/Antitubercular Agents; 0/Platelet Aggregation Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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