Sam's story
Moyamoya disease, direct arterial bypass
Surgery for Moyamoya disease helps Sam after mini-strokes
Sam remembers waking up in the middle of the night, suffering symptoms she thought were a stroke. She felt some drooping on the right side of her face, and her tongue was sore. She even had trouble remembering numbers. For the busy financial analyst, that was a big deal.
"I just couldn't get anything out, and what I could get out didn't make much sense," says Sam, only in her late 30s. "I know that everybody says this, but I didn't think a stroke could happen to me."
She was taken to the emergency room and then to The Jewish Hospital – Mercy Health. It was during these first few hours that she met Dr. Soliman Oushy, a neurosurgeon at Mayfield Brain & Spine, and learned a new term: moyamoya disease.
Moyamoya is a rare disorder caused by narrowing or blocked arteries at the base of the brain. To compensate, the body often forms tiny vessels in the area, appearing on a scan as tangled or as a mass of curls. The Japanese term moyamoya means "puff of smoke."
An angiogram confirmed Sam's moyamoya diagnosis
Dr. Oushy says Sam had likely suffered transient ischemic attacks, or TIAs – often called "mini-strokes." Her right internal carotid artery, a primary source of blood supply to the brain, was nearly completely blocked. As the blood vessels narrowed, Sam was at high risk of having a larger stroke. Dr. Oushy performed an angiogram, a diagnostic test to take pictures of the blood vessels in the brain. Once he confirmed the moyamoya diagnosis, Dr. Oushy recommended surgery to ensure normal blood flow to Sam's brain. The procedure can reduce the risk to lower than 5%, he says.
"Moyamoya disease creates a high risk for patients like Sam, and we don't have a medicine to stop or reverse the progression," Dr. Oushy says. "Fortunately, we have additional options to relieve those symptoms. For example, we can create a direct bypass around the blocked vessels that will both alleviate her symptoms and minimize her long-term risks of a stroke."
When Sam heard the potential options, she did a lot of research on moyamoya disease and joined an online support group. She found that many patients have to travel to large academic health centers to be treated. But thanks to Dr. Oushy and his colleagues at Mayfield, she could find solutions closer to home, leading her to choose to proceed with surgery.
From left: Dr. Robinson, Sam and Dr. Oushy
"I felt like I was pretty lucky," Sam says. "With Dr. Oushy knowing all about moyamoya, and with me transported to a hospital with the capability to handle it, that really helped."
Moyamoya disease is exceptionally rare in the United States but more prevalent in Japan. It is most common in children, and about half of those with moyamoya experience a gradual decline in cognitive function, according to the American Brain Foundation.
"Sam's symptoms from moyamoya fell short of a full ischemic stroke, but her risks were only going to increase during the next several years," Dr. Oushy says.
Sam's surgery involved an open craniotomy through an incision in front of her right ear. Dr. Oushy and another Mayfield neurosurgeon, Dr. Michael Robinson, created a direct path from the superficial temporal artery to the middle cerebral artery, bypassing the blocked blood vessels and providing an immediate source of blood and oxygen to the brain.
Both Dr. Oushy and Dr. Robinson have developed expertise in the direct bypass, a technically demanding procedure that not every surgery practice offers. The alternative is an indirect bypass that allows the brain to create a natural path over time but does not offer immediate protection.
Sam worked up until the day before the surgery and left the hospital the day after the procedure. But today, she is back at work and coaching her son's baseball team.
"There are days when I'm still tired and trying to process it all," she says, "but overall, I'm in much better shape than I was before the surgery."
~ Cliff Peale
Hope Story Disclaimer -"Sam's story" is about one patient's health care experience. Please bear in mind that because every patient is unique, individual patients may respond to treatment in different ways. Results are influenced by many factors and may vary from patient to patient.
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