{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:19:25Z","timestamp":1760059165297,"version":"build-2065373602"},"reference-count":67,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health","award":["RRC 2018-2025","RF-2019-12369247","RCR-2021-23671214","PNRR-MR1-2022-12376618"],"award-info":[{"award-number":["RRC 2018-2025","RF-2019-12369247","RCR-2021-23671214","PNRR-MR1-2022-12376618"]}]},{"name":"Italian Ministry of Health and to the European Union\u2014Next Generation EU\u2014NRRP M6C2\u2014Investment 2.1 Enhancement and strengthening of biomedical research in the NHS","award":["RRC 2018-2025","RF-2019-12369247","RCR-2021-23671214","PNRR-MR1-2022-12376618"],"award-info":[{"award-number":["RRC 2018-2025","RF-2019-12369247","RCR-2021-23671214","PNRR-MR1-2022-12376618"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Moyamoya angiopathy (MMA) is a cerebrovascular disease determining chronic progressive steno-occlusion of the supraclinoid internal carotid arteries and their main branches. The pathogenesis of MMA remains largely unknown. Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system characterized by the progressive accumulation of focal demyelinating lesions, whose pathophysiology has been theorized but still incompletely understood. Beyond misdiagnoses due to mimicking features among the two disorders, MS coexisting with MMA have been previously, rarely, reported. Herein, we present two other cases of patients with MMA with a concomitant, previously missed, diagnosis of MS and discuss their overlapping features as a hint for a potentially shared pathophysiology. The finding of typical angiographic features enables MMA diagnosis, yet it does not allow us to rule out other potentially concomitant disorders affecting the CNS. The association may be easily missed if the clinical\/neuroradiological picture is not carefully assessed. Cerebral spinal fluid analysis and spine neuroimaging should be suggested in all MMA patients with atypical MRI lesions.<\/jats:p>","DOI":"10.3390\/ijms26115030","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T06:35:09Z","timestamp":1747982109000},"page":"5030","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Blurred by a \u201cPuff of Smoke\u201d\u2014A Case-Based Review on the Challenging Recognition of Coexisting CNS Demyelinating Disease and Moyamoya Angiopathy"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0141-0437","authenticated-orcid":false,"given":"Isabella","family":"Canavero","sequence":"first","affiliation":[{"name":"Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0423-8759","authenticated-orcid":false,"given":"Nicola","family":"Rifino","sequence":"additional","affiliation":[{"name":"Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Antozzi","sequence":"additional","affiliation":[{"name":"Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3105-3343","authenticated-orcid":false,"given":"Valentina","family":"Caldiera","sequence":"additional","affiliation":[{"name":"Diagnostic Radiology and Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5265-5055","authenticated-orcid":false,"given":"Elena","family":"Colombo","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5752-1374","authenticated-orcid":false,"given":"Tatiana","family":"Carrozzini","sequence":"additional","affiliation":[{"name":"Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Ganci","sequence":"additional","affiliation":[{"name":"Diagnostic Radiology and Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Ferroli","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Acerbi","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"},{"name":"Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy"},{"name":"Neurosurgery Unit, Pisa University Hospital, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7836-2122","authenticated-orcid":false,"given":"Benedetta","family":"Storti","sequence":"additional","affiliation":[{"name":"Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2551-525X","authenticated-orcid":false,"given":"Giorgio Battista","family":"Boncoraglio","sequence":"additional","affiliation":[{"name":"Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6811-6112","authenticated-orcid":false,"given":"Antonella","family":"Potenza","sequence":"additional","affiliation":[{"name":"Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0256-9706","authenticated-orcid":false,"given":"Giuliana","family":"Pollaci","sequence":"additional","affiliation":[{"name":"Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8483-3509","authenticated-orcid":false,"given":"Gemma","family":"Gorla","sequence":"additional","affiliation":[{"name":"Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6716-2923","authenticated-orcid":false,"given":"Elisa","family":"Ciceri","sequence":"additional","affiliation":[{"name":"Diagnostic Radiology and Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8498-3750","authenticated-orcid":false,"given":"Patrizia","family":"De Marco","sequence":"additional","affiliation":[{"name":"Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6751-5031","authenticated-orcid":false,"given":"Laura","family":"Gatti","sequence":"additional","affiliation":[{"name":"Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2493-628X","authenticated-orcid":false,"given":"Anna","family":"Bersano","sequence":"additional","affiliation":[{"name":"Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S238","DOI":"10.1016\/S0303-8467(97)00082-6","article-title":"Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (\u2018moyamoya\u2019 disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan","volume":"99","author":"Fukui","year":"1997","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/S0198-8859(01)00346-9","article-title":"The major histocompatibility complex influences the ethiopathogenesis of MS-like disease in primates at multiple levels","volume":"62","author":"Brok","year":"2001","journal-title":"Hum. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1002\/ana.1032","article-title":"Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the diagnosis of multiple sclerosis","volume":"50","author":"McDonald","year":"2001","journal-title":"Ann. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1148\/radiol.2232011094","article-title":"\u201cIvy sign\u201d in childhood moyamoya disease: Depiction on FLAIR and contrast-enhanced T1-weighted MR images","volume":"223","author":"Yoon","year":"2002","journal-title":"Radiology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1038\/gim.2015.30","article-title":"Standards and guidelines for the interpretation of sequence variants: A joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology","volume":"17","author":"Richards","year":"2015","journal-title":"Genet. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1097\/NRL.0b013e31826a99a1","article-title":"Moyamoya disease can masquerade as multiple sclerosis","volume":"18","author":"Dorfman","year":"2012","journal-title":"Neurologist"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.msard.2011.10.001","article-title":"Moyamoya: Another multiple sclerosis mimic","volume":"1","author":"Zaheer","year":"2012","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Si, X., Li, L., Fang, Y., Yan, Y., and Pu, J. (2020). A Patient With Multiple Sclerosis and Coexisting Moyamoya Disease: Why and How. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.516587"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"103151","DOI":"10.1016\/j.msard.2021.103151","article-title":"A patient with concurrent multiple sclerosis and moyamoya disease","volume":"54","author":"Koul","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Shamrani, F.A., Al-Khamis, F., Al Ghanimi, I., Khuda, I., Al Jaafari, D., and Alabdali, M. (2015). Moyamoya Disease in Patient with Multiple Sclerosis. Bahrain Med. Bull., 37, Available online: https:\/\/www.bahrainmedicalbulletin.com\/september_2015\/MoyaMoya.pdf.","DOI":"10.12816\/0014449"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1161\/STROKEAHA.111.000307","article-title":"Moyamoya disease in a primarily white, midwestern US population: Increased prevalence of autoimmune disease","volume":"44","author":"Bower","year":"2013","journal-title":"Stroke"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1007\/s00415-019-09245-9","article-title":"Misdiagnoses and delay of diagnoses in Moyamoya angiopathy-a large Caucasian case series","volume":"266","author":"Graf","year":"2019","journal-title":"J. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Canavero, I., Vetrano, I.G., Zedde, M., Pascarella, R., Gatti, L., Acerbi, F., Nava, S., Ferroli, P., Parati, E.A., and Bersano, A. (2021). Clinical Management of Moyamoya Patients. J. Clin. Med., 10.","DOI":"10.3390\/jcm10163628"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1038\/nrneurol.2013.98","article-title":"Uhthoff\u2019s phenomena in MS\u2014Clinical features and pathophysiology","volume":"9","author":"Frohman","year":"2013","journal-title":"Nat. Rev. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/0019-5545.31613","article-title":"Cognitive deficits in psychiatric disorders: Current status","volume":"48","author":"Trivedi","year":"2006","journal-title":"Indian J. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1007\/s00415-009-5425-7","article-title":"Primary central nervous system vasculitis and moyamoya disease: Similarities and differences","volume":"257","author":"Kraemer","year":"2010","journal-title":"J. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/2051-5960-1-14","article-title":"Do brain T2\/FLAIR white matter hyperintensities correspond to myelin loss in normal aging? A radiologic-neuropathologic correlation study","volume":"1","author":"Haller","year":"2013","journal-title":"Acta Neuropathol. Commun."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Wang, B., Li, X., Li, H., Xiao, L., Zhou, Z., Chen, K., Gui, L., Hou, X., Fan, R., and Chen, K. (2022). Clinical, Radiological and Pathological Characteristics Between Cerebral Small Vessel Disease and Multiple Sclerosis: A Review. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.841521"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1136\/jcp.2005.031195","article-title":"Demyelinating diseases","volume":"59","author":"Love","year":"2006","journal-title":"J. Clin. Pathol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1177\/23969873221144089","article-title":"European Stroke Organisation (ESO) Guidelines on Moyamoya angiopathy Endorsed by Vascular European Reference Network (VASCERN)","volume":"8","author":"Bersano","year":"2023","journal-title":"Eur. Stroke J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.3171\/2015.6.JNS15845","article-title":"Periventricular anastomosis in moyamoya disease: Detecting fragile collateral vessels with MR angiography","volume":"124","author":"Funaki","year":"2016","journal-title":"J. Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.msard.2018.05.011","article-title":"2017 McDonald diagnostic criteria: A review of the evidence","volume":"24","author":"McNicholas","year":"2018","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1007\/s00415-017-8458-3","article-title":"Moyamoya disease mimicking the first attack of multiple sclerosis","volume":"264","author":"Preziosa","year":"2017","journal-title":"J. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria","volume":"17","author":"Thompson","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s00330-015-3802-4","article-title":"CT perfusion assessment of Moyamoya syndrome before and after direct revascularization (superficial temporal artery to middle cerebral artery bypass)","volume":"26","author":"Chen","year":"2016","journal-title":"Eur. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/cns.13106","article-title":"Moyamoya disease presenting as thalamic infarction in a patient with neuromyelitis optica spectrum disorder","volume":"25","author":"Zhang","year":"2019","journal-title":"CNS Neurosci. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Liu, W., Morito, D., Takashima, S., Mineharu, Y., Kobayashi, H., Hitomi, T., Hashikata, H., Matsuura, N., Yamazaki, S., and Toyoda, A. (2011). Identification of RNF213 as a susceptibility gene for moyamoya disease and its possible role in vascular development. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0022542"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1038\/jhg.2010.132","article-title":"A genome-wide association study identifies RNF213 as the first Moyamoya disease gene","volume":"56","author":"Kamada","year":"2011","journal-title":"J. Hum. Genet."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"5961","DOI":"10.1038\/s41467-024-50392-z","article-title":"RNF213 promotes Treg cell differentiation by facilitating K63-linked ubiquitination and nuclear translocation of FOXO1","volume":"15","author":"Yang","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Vilari\u00f1o-G\u00fcell, C., Zimprich, A., Martinelli-Boneschi, F., Herculano, B., Wang, Z., Matesanz, F., Urcelay, E., Vandenbroeck, K., Leyva, L., and Gris, D. (2019). Exome sequencing in multiple sclerosis families identifies 12 candidate genes and nominates biological pathways for the genesis of disease. PLoS Genet., 15, Erratum in PLoS Genet. 2020, 16, e1008737.","DOI":"10.1371\/journal.pgen.1008737"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1212\/WNL.0000000000201720","article-title":"Genetic Causes of Cerebral Small Vessel Diseases: A Practical Guide for Neurologists","volume":"100","author":"Manini","year":"2023","journal-title":"Neurology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1093\/brain\/awz024","article-title":"Association of variants in HTRA1 and NOTCH3 with MRI-defined extremes of cerebral small vessel disease in older subjects","volume":"142","author":"Mishra","year":"2019","journal-title":"Brain"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e200176","DOI":"10.1212\/NXG.0000000000200176","article-title":"Blended Phenotype of NOTCH3 and RNF213 Variants with Accelerated Large and Small Artery Crosstalk: A Case Report and Literature Review","volume":"10","author":"Saito","year":"2024","journal-title":"Neurol. Genet."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1159\/000442298","article-title":"European Moyamoya Disease Initiative. Research Progresses in Understanding the Pathophysiology of Moyamoya Disease","volume":"41","author":"Bersano","year":"2016","journal-title":"Cerebrovasc. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Weng, L., Cao, X., Han, L., Zhao, H., Qiu, S., Yan, Y., Wang, X., Chen, X., Zheng, W., and Xu, X. (2017). Association of increased Treg and Th17 with pathogenesis of moyamoya disease. Sci. Rep., 7.","DOI":"10.1038\/s41598-017-03278-8"},{"key":"ref_36","first-page":"31","article-title":"Autoimmune antibody in moyamoya disease","volume":"14","author":"Wanifuchi","year":"1986","journal-title":"No Shinkei Geka"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1177\/0961203307087375","article-title":"Moyamoya syndrome associated with systemic lupus erythematosus","volume":"17","author":"Jeong","year":"2008","journal-title":"Lupus"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.jstrokecerebrovasdis.2010.03.006","article-title":"Moyamoya syndrome associated with Graves\u2019 disease: A case report and review of the literature","volume":"20","author":"Malik","year":"2011","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1159\/000088666","article-title":"Angiographic findings of moyamoya vessels in a patient with rheumatoid arthritis","volume":"20","author":"Paciaroni","year":"2005","journal-title":"Cerebrovasc. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e28756","DOI":"10.1097\/MD.0000000000028756","article-title":"Moyamoya disease with Sjogren disease and autoimmune thyroiditis presenting with left intracranial hemorrhage after messenger RNA-1273 vaccination: A case report","volume":"101","author":"Lin","year":"2022","journal-title":"Medicine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/j.1600-0404.2010.01428.x","article-title":"Clinical features of Sjogren\u2019s syndrome in patients with multiple sclerosis","volume":"124","author":"Annunziata","year":"2011","journal-title":"Acta Neurol. Scand."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"578226","DOI":"10.1016\/j.jneuroim.2023.578226","article-title":"Comorbid autoimmune disorders in people with multiple sclerosis: A retrospective cohort study","volume":"385","author":"Santos","year":"2023","journal-title":"J. Neuroimmunol."},{"key":"ref_43","unstructured":"(2025, February 27). OMIM. Available online: https:\/\/www.omim.org\/entry\/618999."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1089\/jir.2014.0012","article-title":"Involvement of the janus kinase\/signal transducer and activator of transcription signaling pathway in multiple sclerosis and the animal model of experimental autoimmune encephalomyelitis","volume":"34","author":"Benveniste","year":"2014","journal-title":"J. Interferon Cytokine Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4185","DOI":"10.1016\/j.apsb.2023.07.026","article-title":"JAK inhibition ameliorated experimental autoimmune encephalomyelitis by blocking GM-CSF-driven inflammatory signature of monocytes","volume":"13","author":"Shao","year":"2023","journal-title":"Acta Pharm. Sin. B."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1590\/0100-3984.2021.0010","article-title":"Moyamoya disease and syndrome: A review","volume":"55","author":"Koppe","year":"2022","journal-title":"Radiol. Bras."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"408","DOI":"10.3340\/jkns.2015.57.6.408","article-title":"Moyamoya Syndrome: A Window of Moyamoya Disease","volume":"57","author":"Phi","year":"2015","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"267","DOI":"10.2176\/nmc.52.267","article-title":"Review of past research and current concepts on the etiology of moyamoya disease","volume":"52","author":"Houkin","year":"2012","journal-title":"Neurol. Med. Chir."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Imani, S.Z.H., Hojati, Z., Khalilian, S., Dehghanian, F., Kheirollahi, M., Khorrami, M., Shaygannejad, V., and Mirmosayyeb, O. (2021). Expression and clinical significance of IL7R, NFATc2, and RNF213 in familial and sporadic multiple sclerosis. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-98691-5"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Cashion, J.M., Young, K.M., and Sutherland, B.A. (2023). How does neurovascular unit dysfunction contribute to multiple sclerosis?. Neurobiol. Dis., 178.","DOI":"10.1016\/j.nbd.2023.106028"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Yang, R., and Dunn, J.F. (2015). Reduced cortical microvascular oxygenation in multiple sclerosis: A blinded, case-controlled study using a novel quantitative near-infrared spectroscopy method. Sci. Rep., 5.","DOI":"10.1038\/srep16477"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1212\/01.WNL.0000101723.79681.38","article-title":"Vitamin D intake and incidence of multiple sclerosis","volume":"62","author":"Munger","year":"2004","journal-title":"Neurology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2832","DOI":"10.1001\/jama.296.23.2832","article-title":"Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis","volume":"296","author":"Munger","year":"2006","journal-title":"JAMA"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.msard.2017.07.020","article-title":"Smoking and multiple sclerosis: A systematic review and meta-analysis using the Bradford Hill criteria for causation","volume":"17","author":"Degelman","year":"2017","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1177\/1352458512436596","article-title":"High body mass index before age 20 is associated with increased risk for multiple sclerosis in both men and women","volume":"18","author":"Olsson","year":"2012","journal-title":"Mult. Scler."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1177\/1352458513483889","article-title":"Childhood body mass index and multiple sclerosis risk: A long-term cohort study","volume":"19","author":"Munger","year":"2013","journal-title":"Mult. Scler."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Pepper, R.E., Pitman, K.A., Cullen, C.L., and Young, K.M. (2018). How Do Cells of the Oligodendrocyte Lineage Affect Neuronal Circuits to Influence Motor Function, Memory and Mood?. Front. Cell. Neurosci., 12.","DOI":"10.3389\/fncel.2018.00399"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.neulet.2009.12.059","article-title":"Increased blood vessel density and endothelial cell proliferation in multiple sclerosis cerebral white matter","volume":"470","author":"Holley","year":"2010","journal-title":"Neurosci. Lett."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1161\/01.STR.27.9.1641","article-title":"Cerebral white matter is highly vulnerable to ischemia","volume":"27","author":"Pantoni","year":"1996","journal-title":"Stroke"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1523\/JNEUROSCI.3516-10.2011","article-title":"Regulation of oligodendrocyte development and myelination by glucose and lactate","volume":"31","author":"Rinholm","year":"2011","journal-title":"J. Neurosci."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s00401-009-0618-9","article-title":"Gene expression analysis of the microvascular compartment in multiple sclerosis using laser microdissected blood vessels","volume":"119","author":"Cunnea","year":"2010","journal-title":"Acta Neuropathol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e114","DOI":"10.1097\/CCM.0b013e3182a641b8","article-title":"Sepsis is associated with altered cerebral microcirculation and tissue hypoxia in experimental peritonitis","volume":"42","author":"Taccone","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/BF03164835","article-title":"Clinical significance of reduced cerebral metabolism in multiple sclerosis: A combined PET and MRI study","volume":"12","author":"Sun","year":"1998","journal-title":"Ann. Nucl. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3670","DOI":"10.1007\/s12035-016-9915-1","article-title":"Molecular Mechanisms of Vascular Dementia: What Can Be Learned from Animal Models of Chronic Cerebral Hypoperfusion?","volume":"54","author":"Du","year":"2017","journal-title":"Mol. Neurobiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.autrev.2018.01.001","article-title":"Diagnosis and management of neuromyelitis optica spectrum disorders\u2014An update","volume":"17","author":"Bruscolini","year":"2018","journal-title":"Autoimmun. Rev."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"619.e7","DOI":"10.1016\/j.jstrokecerebrovasdis.2011.01.003","article-title":"Moyamoya disease presenting as thalamic hemorrhage in a patient with neuromyelitis optica and Sj\u00f6gren\u2019s syndrome","volume":"21","author":"Asai","year":"2012","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1093\/omcr\/omu006","article-title":"Moyamoya disease in a patient with neuromyelitis optica","volume":"2014","author":"Chan","year":"2014","journal-title":"Oxf. Med. 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