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首页> 外文期刊>JAMA otolaryngology-- head & neck surgery >Stroke after adenotonsillectomy in patients with undiagnosed moyamoya syndrome
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Stroke after adenotonsillectomy in patients with undiagnosed moyamoya syndrome

机译：未确诊烟雾病综合征患者的腺扁桃体切除术中风

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摘要

IMPORTANCE Moyamoya syndrome is a rare, occlusive cerebrovascular arteriopathy with significant risk for stroke. Populations that frequently undergo otolaryngologic procedures, including patients with Down syndrome and sickle cell disease, are particularly at risk for moyamoya. The initial presentation of moyamoya syndrome as stroke in the perioperative period of an otolaryngologic procedure has not been reported.OBSERVATIONS A retrospective medical record review assessed the relationship of otolaryngologic operations and the onset ofmoyamoya symptoms. Moyamoya syndrome was present in 137 patients. Of these, 19 patients underwent otolaryngologic procedures; 3 children had strokes 2 to 4 days after adenotonsillectomy, including 2 children with Down syndrome. Intraoperative carotid artery injury was considered but was proven not to be the cause of stroke. Bilateral moyamoya disease was diagnosed in all 3 patients via vascular imaging studies; all subsequently underwent revascularization procedures.CONCLUSIONS AND RELEVANCE Clinicians should be aware of an elevated prevalence of moyamoya syndrome in Down syndrome and sickle cell disease populations and should consider moyamoya syndrome in the differential diagnosis of postoperative stroke. Stroke risk is magnified in the perioperative setting related to perioperative dehydration and hypotension. Awareness and screening for cerebral vasculopathy in high-risk populations could prompt measures to decrease the occurrence of postoperative strokes after adenotonsillectomies.
机译：重要说明Moyamoya综合征是一种罕见的闭塞性脑血管动脉病，具有中风的重大风险。经常接受耳鼻喉科手术的人群，包括唐氏综合症和镰状细胞病患者，尤其容易患烟雾病。尚未报道在耳鼻喉科手术围手术期最初将Moyamoya综合征表现为中风。回顾性病历回顾评估了耳鼻喉科手术与Moyamoya症状发作之间的关系。 137例患者出现Moyamoya综合征。其中19例接受耳鼻喉科手术;腺扁桃体切除术后2至4天有3名儿童中风，包括2名唐氏综合症儿童。术中考虑过颈动脉损伤，但事实证明并非引起中风。通过血管成像研究，所有3例患者均被诊断出双侧烟雾病。结论和相关性临床医生应意识到唐氏综合症和镰状细胞疾病人群中烟雾综合症的患病率升高，并应在术后卒中的鉴别诊断中考虑烟雾综合症。与围手术期脱水和低血压有关的围手术期中风风险被放大。对高危人群进行脑血管病变的认识和筛查可以促使采取措施减少腺苷化肌电击术后术后中风的发生。

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