A case of reversible stenosis in the cervical internal carotid artery causing cerebral infarction associated with Basedow disease

歩希, 中村; 康史, 小菅; 宜隆, 水庭; 大輔, 和久井; 芳雄, 田口

doi:10.3995/jstroke.36.51

Cited by 2 publications

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“…The remaining 2 patients (cases 5 and 6) were treated with antithyroid and immunosuppressive agents [8,9]. In cases 1-3 and our case, Bas-MMV improved after a few months, and residual stenosis was more likely to be observed [4][5][6]. In case 4, the patient was treated via angioplasty using verapamil during the acute phase of ischemic stroke, and improvement in MMV to some extent was observed.…”

Section: Discussionmentioning

confidence: 86%

“…Table 1 shows a summary of 6 case reports [4][5][6][7][8][9] which showed improvement in Bas-MMV during the clinical course. Three patients (cases 1-3) and the patient in this case report were treated with an antithyroid drug [4][5][6], and 1 patient (case 4) was treated with an antithyroid drug and angioplasty [7]. The remaining 2 patients (cases 5 and 6) were treated with antithyroid and immunosuppressive agents [8,9].…”

Section: Discussionmentioning

confidence: 99%

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Fluctuations in Moyamoya Vasculopathy Associated with Basedow Disease Depending on Thyroid Hormone Status

et al. 2020

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A 31-year-old woman presented with sudden onset of weakness in her left upper limb. Magnetic resonance imaging revealed acute cerebral infarctions in the right frontal and parietal lobes. Magnetic resonance angiography showed stenosis in the proximal portions of the bilateral middle cerebral arteries and terminal portions of the bilateral internal carotid arteries. The patient also complained of thyrotoxic symptoms, such as tachycardia, goiter, and fine finger tremor. She was diagnosed with acute ischemic stroke due to moyamoya vasculopathy (MMV) associated with Basedow disease. The patient's thyroid hormone status normalized and intracranial artery stenosis gradually improved. However, after 6 months, she developed transient left hemiparesis during the 7th week of gestation. Her thyroid function deteriorated, and MMV

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Fluctuations in Moyamoya Vasculopathy Associated with Basedow Disease Depending on Thyroid Hormone Status

et al. 2020

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Progressive stenosis and radiological findings of vasculitis over the entire internal carotid artery in moyamoya vasculopathy associated with graves’ disease: a case report and review of the literature

et al. 2019

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Background Moyamoya vasculopathy (MMV) associated with Graves’ disease (GD) is a rare condition resulting in ischemic stroke accompanied by thyrotoxicity. Radiological findings of vasculitis have been reported in the walls of distal internal carotid arteries (ICAs) in these patients; however, no reports have described in detail the processes of progression of the lesions in the proximal ICA. Moreover, treatments to prevent recurrence of ischemic stroke and progression of MMV have not yet been sufficiently elucidated. Case presentation We report a progressive case of MMV associated with GD and review the literature to clarify relationships among recurrence, progression, thyrotoxicity and treatment. Our patient developed cerebral infarction during thyrotoxicity with no obvious stenosis of ICAs. Five months later, transient ischemic attacks recurred with thyrotoxicity. Antiplatelet therapy and intravenous methylprednisolone stopped the attacks. Stenosis of the left ICA from the proximal to distal portion and champagne bottle neck sign (CBN) were found. She declined any surgery. Afterward, gradual progression with mild thyrotoxicity was observed. Eventually, we found smooth, circumferential, concentric wall thickening with diffuse gadolinium enhancement of the left ICA from the proximal to the distal portion on T1-weighted imaging, suggesting vasculitis radiologically. The clinical and radiological similarities to Takayasu arteritis encouraged us to provide treatment as for vasculitis of medium-to-large vessels. In a euthyroid state and after administration of prednisolone and methotrexate, improved flow in the cerebrovascular arteries on magnetic resonance angiography was observed. Based on our review of the literature, all cases with recurrence or progression were treated with anti-thyroid medication (ATM) alone and accompanied by thyrotoxicity. CBN was observed in all previous cases for which images of the proximal ICA were available. Conclusions We report the details of progressive stenosis from a very early stage and radiological findings of vasculitis over the entire ICA in MMV associated with GD. Cerebral infarction can occur with no obvious stenosis of the ICA. We treated the patient as per vasculitis of a medium-to-large vessel. Management of GD by ATM alone seems risky in terms of recurrence. Adequate management of GD and possible vasculitis may be important for preventing recurrence and progression. Electronic supplementary material The online version of this article (10.1186/s12883-019-1262-1) contains supplementary material, which is available to authorized users.

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A case of reversible stenosis in the cervical internal carotid artery causing cerebral infarction associated with Basedow disease

Cited by 2 publications

References 7 publications

Fluctuations in Moyamoya Vasculopathy Associated with Basedow Disease Depending on Thyroid Hormone Status

Fluctuations in Moyamoya Vasculopathy Associated with Basedow Disease Depending on Thyroid Hormone Status

Progressive stenosis and radiological findings of vasculitis over the entire internal carotid artery in moyamoya vasculopathy associated with graves’ disease: a case report and review of the literature

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