Moyamoya Disease in Latin America: A Case Report with Systematic Review and Meta-Analysis
Fritz Fidel Váscones-Román1, Brigith Avila Lucas1, Marcelo Barriga1, Niels Pacheco2, Frank G Solis Chucos3
1Cayetano Heredia Peruvian University, 2Harvard Medical School, 3Instituto Nacional de Ciencias Neurológicas
Objective:
To examine the clinical characteristics, diagnostic approaches, and treatment outcomes of Moyamoya disease (MMD) in Latin America through a case report and a systematic review and meta-analysis.
Background:
Moyamoya disease is a rare cerebrovascular disorder involving progressive stenosis of the internal carotid arteries and abnormal collateral vessel formation. While most prevalent in East Asia, MMD also affects other populations, including those in Latin America, where its presentation and outcomes are less well understood.
Design/Methods:
We conducted a systematic review of Latin American MMD cases, following PRISMA guidelines. Databases searched included PubMed, Embase, and Scopus. Case reports, case series, and cohort studies were analyzed. Data extraction focused on patient demographics, clinical presentation, diagnostic tools, treatments, and outcomes. Meta-analysis was performed, and the risk of bias was assessed using the Joanna Briggs Institute checklist.
Results:
Twenty-one studies, involving 32 patients from Brazil, Mexico, Colombia, Cuba, and Peru, were included. Ischemic strokes were the most common presentation (78%), followed by hemorrhagic events (22%). Digital subtraction angiography (DSA) was the preferred diagnostic method. Treatments varied from medical management to surgical revascularization, such as encephaloduroarteriosynangiosis (EDAS). Meta-analysis showed 40% of patients experienced neurological sequelae, while 78% had favorable outcomes, especially with surgical interventions.
Conclusions:
Moyamoya disease in Latin America predominantly manifests as ischemic events, with DSA as the primary diagnostic tool. Surgical revascularization appears to result in better recovery compared to medical treatment alone. However, due to limited data, further research is needed to better understand MMD in this region and improve treatment strategies.
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