An extensive posterior circulation infarction secondary to primary hyperthyroidism accompanied with superior mesenteric artery syndrome

Abstract

Introduction: Hyperthyroidism-related anterior circulation ischemic events have been well documented; however, posterior circulation infarction is rarely reported, not to mention with superior mesenteric artery syndrome (SMAS), which has never been reported concurrently. We describe, to the best of our knowledge, the first case of hyperthyroidism-related cerebellar infarction accompanied with SMAS. Patient concerns: A 22-year-old women presented with palpitation, postprandial vomiting, and acute body weight loss. Enlarged thyroid gland was discovered in physical examination and Graves disease was diagnosed by blood test; therefore, Propylthiouracil and β-blocker were prescribed. Sudden onset conscious disturbance accompanied with apnea was noted during hospitalization. Diagnosis: Computed tomography (CT) revealed cerebellar infarction with severe cerebellar swelling and tonsil herniation; hence, emergent suboccipital craniotomy and bilateral tonsillectomy were performed. Interventions: Nevertheless, persisted poor passage of liquid diet during nasogastric tube feeding was noted after operation. CT of abdomen showed a sharp aorta-SMA angle (15°) and a short distance between aorta and SMA (6 mm) indicating a diagnosis of SMAS. Outcomes: After parental nutrition supplement and progressive rehabilitation program, she recovered to a modified Rankin Scale of 3. Conclusion: Although rarely reported, hyperthyroidism-related sympathetic hyperstimulation, vasculopathy could result in potentially deadly posterior circulation infarction. Furthermore, SMAS should be considered in the cases of hyperthyroidism with prolonged gastrointestinal symptoms even after treatment and should be treated simultaneously, since SMAS exacerbates depletion of intravascular volume. Further study to clarify the relation between hyperthyroidism and posterior circulation hemodynamic status is suggested.

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

“…The diagnosis is difficult because of the risk of cystic fibrosis enteropathy[ 24 ]. Other rare associations are hyperthyroidism-related sympathetic hyperstimulation, vasculopathy and cerebellar infarction[ 46 ] and diabetic patients with excessive body weight loss and associated ketoacidosis after using sodium-glucose cotransporter 2 inhibitors[ 47 ]. Rare associations with rheumatoid arthritis and rheumatoid cachexia have also been reported[ 48 ].…”

Superior Mesenteric Artery Syndrome Accompanied by Acute-onset Type 1 Diabetes Complicated with Graves' Disease

“…Given that both diabetes and Graves' disease induce wasting among those affected by these disorders, a combination of these diseases can precipitate SMAS. However, there have only been a few studies concerning the incidence of SMAS due to diabetes and Graves' disease ( 8 , 9 ). More importantly, such studies have shown that SMAS usually occurs after a long duration of diabetes.…”