What to Do If You Experience Hemorrhage from Moyamoya Disease

Moyamoya disease is a rare cerebrovascular disorder that can lead to life-threatening complications, including intracranial hemorrhage. When bleeding occurs in the brain due to this condition, prompt and appropriate medical intervention is essential to minimize damage and improve long-term outcomes.

Immediate Medical Response to Hemorrhage

If a patient with moyamoya disease experiences a brain bleed, it is critical to seek immediate care at a specialized neurological center. Neurosurgical teams are best equipped to assess the severity of the hemorrhage and determine the most effective course of action. In cases of minor bleeding, the body may naturally reabsorb the blood over time without invasive procedures. However, when the volume of blood is significant, interventions such as ventricular drainage may be necessary to relieve pressure on the brain and prevent further neurological deterioration.

Avoiding Surgery During the Acute Phase

It's important to note that surgical treatment is generally not recommended during the acute phase of a hemorrhagic event. The brain is highly vulnerable during this period, and operating too soon can increase the risk of complications. Instead, the focus shifts to stabilizing the patient, managing symptoms, and closely monitoring for any changes in neurological status.

Preventing Rebleeding in the First 90 Days

The first three months following a hemorrhagic episode are considered a high-risk window for rebleeding. During this critical period, strict preventive measures must be taken. This includes controlling blood pressure, avoiding activities that cause sudden spikes in intracranial pressure, and adhering to prescribed medications. Patients should maintain regular follow-ups with their neurologist to ensure optimal management and reduce the likelihood of another stroke or hemorrhage.

Long-Term Treatment: Revascularization Surgery

Approximately three months after the initial hemorrhage, once the patient has stabilized, doctors may recommend revascularization surgery. This procedure aims to restore proper blood flow to the brain by creating new pathways for circulation, effectively bypassing the blocked or narrowed arteries characteristic of moyamoya disease. Common techniques include direct bypass (such as STA-MCA anastomosis) or indirect methods like encephaloduroarteriosynangiosis (EDAS). These surgeries significantly reduce the risk of future strokes and hemorrhages.

Early Diagnosis and Proactive Management

One of the most effective strategies in dealing with moyamoya disease is early detection. Many patients remain asymptomatic until a major event like a stroke or hemorrhage occurs. Therefore, individuals with a family history or unexplained neurological symptoms should undergo imaging studies such as MRI or angiography for timely diagnosis. Early intervention can halt disease progression and dramatically improve quality of life.

In summary, managing hemorrhage in moyamoya disease requires a comprehensive, phased approach—starting with emergency stabilization, followed by vigilant short-term monitoring, and culminating in long-term surgical solutions. The primary goals are always preventing recurrent bleeding and protecting brain function. With advances in neurosurgery and improved awareness, patients today have better prognoses than ever before when under expert care.