Identification of associations and distinguishing moyamoya disease from ischemic strokes of other etiologies: A retrospective case-control study

Cori Xiu Yue Sutton; Enrique Carrazana; Catherine Mitchell; Jason Viereck; Kore Kai Liow; Arash Ghaffari-Rafi

doi:10.1016/j.amsu.2022.103771

Identification of associations and distinguishing moyamoya disease from ischemic strokes of other etiologies: A retrospective case-control study

Ann Med Surg (Lond). 2022 May 11:78:103771. doi: 10.1016/j.amsu.2022.103771. eCollection 2022 Jun.

Authors

Cori Xiu Yue Sutton¹, Enrique Carrazana^{1

2}, Catherine Mitchell², Jason Viereck^{1

2}, Kore Kai Liow^{1

2}, Arash Ghaffari-Rafi^{1

3}

Affiliations

¹ University of Hawai'i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA.
² Hawai'i Pacific Neuroscience, Brain Research, Innovation and Translation Lab, Honolulu, HI, USA.
³ University of California Davis, School of Medicine, Department of Neurological Surgery, Sacramento, CA, USA.

Abstract

Introduction: Better characterizing moyamoya disease (MMD) from ischemic strokes of other etiologies may facilitate earlier diagnosis by raising suspicion for a diagnostic work-up.

Methods: To identify associated variables, MMD cases (n = 12) were compared against three sets of controls: age-, sex-, and race-matched controls of patients with general neurological disorders (n = 48), unmatched general controls (n = 48), and unmatched non-MMD ischemic stroke controls (n = 48).

Results: MMD patients were 32 years (p < 0.0001) younger than ischemic stroke controls. Relative to non-MMD ischemic strokes, MMD patients had greater odds of presenting with visual field defects (OR: 9.13, p = 0.09) or dizziness (OR: 9.13, p = 0.09), as well as being female (OR: 8.04, p = 0.008), Asian (OR: 3.68, p = 0.087), employed (OR: 6.96, p = 0.02), having migraines (OR: 21.61, p = 0.005), epilepsy (OR: 6.69, p = 0.01), insomnia (OR: 8.90, p = 0.099), and a lower Charlson Comorbidity Index (CCI; p = 0.002). Patients with MMD, compared to non-MMD ischemic strokes, also had a 4.67 kg/ $m^{2}$ greater body mass index (BMI) and larger odds (OR relative to normal BMI: 21.00, p = 0.03) of being from obesity class III (>40 kg/ $m^{2}$ ), yet reduced odds of coronary artery disease (OR: 0.13, p = 0.02). Relative to general controls, MMD patients had greater odds of diabetes mellitus type 2 (OR: 10.07, p = 0.006) and hypertension (OR: 7.28, p = 0.004).

Conclusion: MMD not only has a unique clinical presentation from other ischemic strokes, but also unique comorbidities, which may facilitate earlier work-up and treatment.

Keywords: ACA, Anterior Cerebral Artery; CCI, Charlson Comorbidity Index; Cardiovascular; ICD-10, International Classification of Diseases 10th Edition; ICD-9, International Classification of Diseases 9th Edition; Ischemic stroke; MCA, Middle Cerebral Artery; MMD, Moyamoya Disease:; Migraines; Moyamoya disease; NHPI, Native Hawaiian or Other Pacific Islander; PCA, Posterior Cerebral Artery; Socioeconomic; TIA, Transient Ischemic Attack.