Misdiagnoses and delay of diagnoses in Moyamoya angiopathy

• Verfasst von: Graf, Jonas Maximilian [VerfasserIn]
• Verfasst von: Veltkamp, Roland [VerfasserIn]
• Titel: Misdiagnoses and delay of diagnoses in Moyamoya angiopathy
• Titelzusatz: a large Caucasian case series
• Verf.angabe: Jonas Graf, Jan Claudius Schwitalla, Philipp Albrecht, Roland Veltkamp, Peter Berlit, Hans-Peter Hartung, Orhan Aktas, Markus Kraemer
• E-Jahr: 2019
• Jahr: 25 February 2019
• Umfang: 7 S.
• Fussnoten: Gesehen am 20.05.2019
• Titel Quelle: Enthalten in: Journal of neurology
• Ort Quelle: [Darmstadt] : Steinkopff, 1891
• Jahr Quelle: 2019
• Band/Heft Quelle: 266(2019), 5, Seite 1153-1159
• ISSN Quelle: 1432-1459
• DOI: doi:10.1007/s00415-019-09245-9
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Misdiagnosis
• Sach-SW: Moyamoya
• Sach-SW: Multiple sclerosis
• Sach-SW: Vasculitis
• K10plus-PPN: 1665920300

Abstract

BackgroundThe lacking awareness of healthcare providers bears the risk of delayed or false diagnoses in rare diseases. No systematic data about misdiagnoses of Moyamoya angiopathy (MMA) are available.ObjectiveTo evaluate the rate and pattern of missed diagnoses in MMA.MethodsRetrospective analysis of a consecutive case series from a single German referral center. Rates of missed or delayed diagnoses in Caucasian MMA patients were calculated based on discharge letters from other hospitals and systematic chart review.ResultsOut of 192 Caucasian patients eventually diagnosed with MMA at our center, an initial misdiagnosis was identified in 119 patients (62%). The time between onset and diagnosis was 1 year in 24 patients, 2 years in 23 patients, 3 years in 10 patients, and > 3 years in 49 patients (mean 5.28, median 3, standard deviation 5.11, and range 4-26 years). The most common misdiagnoses were cerebral vasculitis (31%), etiologically ill-defined stroke diagnoses (30.2%), and MS (3.6%).ConclusionsThis is the first systematic report which shows that patients with MMA are at high risk to be falsely diagnosed and treated. Depiction of typical vascular abnormalities in angiopathy is essential. Normal CSF cell counts, negative oligoclonal bands, and lack of infratentorial lesions as well as gadolinium-positive T1 lesions on MRI may be red flags differentiating this vasculopathy from vasculitis and MS.