Background:Moyamoya angiopathy (MMA) can present with a variety of neurological symptoms which are often precipitated in close association to various precipitating factors. This study analyzes the precipitating triggers to neurological symptoms done on the largest cohort of MMA in India.
Methods:A single-centered, cross-sectional observational study, recruiting 400 patients with consecutive angiographically proven MMA over a period of 8 years (2016–2023), was undertaken to evaluate the profile of immediate precipitating factors in temporal association to the neurological symptoms, along with their clinical and radiological characteristics. SPSS 25 was used for statistical analysis.
Results:Among the 400 patients (Adult-220, children-180), precipitating factors were seen in 42.0%, significantly higher in children (54.4%) than adults (31.8%) (p value: 0.011). The commonest triggers included fever (18.0%), emotional stress (8.8%), heavy exercise and diarrhea (6.5% each). Cold bath triggered MMA symptoms in 1.5%. Fever (p value: 0.009) and persistent crying (p value: 0.01) triggered neurological symptoms more commonly in children than in adults. Amongst MMA patients with precipitating factors, the commonest MMA presentation included cerebral infarction type (37.5%) and TIA (32.1%). The majority of precipitating factors that preceded an ischemic event were BP-lowing ones (55.6%).
Conclusion:The occurrence of neurological symptoms of MMA in close association to several precipitating factors is not uncommon. The epidemiology of precipitating factors vary with the age of presentation and type of MMA. The presence of certain precipitating factors can serve as an early diagnostic clue to MMA and its careful avoidance can result in attenuation of distressing transient neurological symptoms.