Ahn Annie K, Honeybrook Adam, Jordan Lori C, Singer Robert J, Tylor Dale A
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina.
JAMA Otolaryngol Head Neck Surg. 2014 Nov;140(11):1061-4. doi: 10.1001/jamaoto.2014.1990.
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.
A retrospective medical record review assessed the relationship of otolaryngologic operations and the onset of moyamoya 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.
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.
烟雾病综合征是一种罕见的闭塞性脑血管动脉病，具有显著的中风风险。经常接受耳鼻喉科手术的人群，包括唐氏综合征和镰状细胞病患者，尤其有患烟雾病的风险。烟雾病综合征在耳鼻喉科手术围手术期以中风为首发表现的情况尚未见报道。
一项回顾性病历审查评估了耳鼻喉科手术与烟雾病症状发作之间的关系。137例患者存在烟雾病综合征。其中，19例患者接受了耳鼻喉科手术；3名儿童在腺样体扁桃体切除术后2至4天发生中风，其中2名儿童患有唐氏综合征。考虑过术中颈动脉损伤，但经证实并非中风原因。通过血管成像研究确诊所有3例患者均为双侧烟雾病；所有患者随后均接受了血运重建手术。
临床医生应意识到唐氏综合征和镰状细胞病患者中烟雾病综合征的患病率较高，并应在术后中风的鉴别诊断中考虑烟雾病综合征。围手术期脱水和低血压会增加围手术期的中风风险。对高危人群的脑血管病变进行认知和筛查，可能会促使采取措施减少腺样体扁桃体切除术后中风的发生。
