Graves' Thyrotoxicosis and Moyamoya Disease

Kushima, K; Satoh, Yoshikazu; Ban, Yoshio; Taniyama, Matsuo; Ito, Kunihiko; Sugita, Koujiro

doi:10.1017/s0317167100031607

Cited by 46 publications

(39 citation statements)

References 4 publications

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“…Table 1 shows the 14 reported cases of Basedow's disease associated with stenosis of the terminal portion of ICA including moyamoya disease. [4][5][6]9,10,13,15) In the present case, MR angiography revealed steno- sis of the bilateral distal ICAs, and the bilateral proximal ACAs and MCAs. Moyamoya disease was considered in the differential diagnosis.…”

Section: Case Reportmentioning

confidence: 69%

“…Basedow's disease is very rarely associated with stenosis of the terminal portion of the internal carotid arteries (ICAs). [4][5][6]9,10,13,15) Recently, we treated a patient with thyroid crisis complicated by ischemic manifestations, and thorough investigations revealed concomitant stenosis of the terminal portion of the ICAs. Treatment for Basedow's disease also led to improvement of the stenosis of the terminal portion of the ICAs.…”

Section: Introductionmentioning

confidence: 99%

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Improvement of Cerebral Arterial Stenosis Associated With Basedow's Disease-Case Report-

Yamashita

Tamiya

Shindo

et al. 2005

Neurol. Med. Chir.(Tokyo)

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A 29-year-old female presented with Basedow's disease manifesting as sudden vomiting, diarrhea, fever over 389 C, transient aphasia, and numbness in her extremities. These symptoms were considered due to cerebral ischemia at a local clinic. Magnetic resonance angiography indicated stenosis of the bilateral distal internal carotid arteries and the bilateral proximal anterior cerebral and middle cerebral arteries. Thyroid swelling and exophthalmos were observed. She was transferred to our hospital. Endocrine function tests showed hyperthyroidism. The diagnosis was Basedow's disease. Her symptoms disappeared after receiving intravenous drip infusion of fluid replacement, and antithyroid and antiplatelet medication. After she became euthyroid, cerebral angiography and magnetic resonance angiography revealed improvement of the stenosis of the cerebral arteries. Stenosis of the terminal portion of the internal carotid artery associated with Basedow's disease is extremely rare. Conservative treatment mainly including antithyroid medications for Basedow's disease, and antiplatelet drugs and intravenous replacement fluid for the ischemic manifestations should be the first choice of treatment unless immediate vascular reconstruction is necessary.

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Section: Case Reportmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Improvement of Cerebral Arterial Stenosis Associated With Basedow's Disease-Case Report-

Yamashita

Tamiya

Shindo

et al. 2005

Neurol. Med. Chir.(Tokyo)

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“…A doença cerebrovascular isquêmica nos pacientes com hipertireoidismo costuma estar relacionada aos eventos cárdio-embólicos decorrentes da fibrilação atrial na tireotoxicose [31][32][33][34] , embora já tenham sido descritas algumas alterações vasculares intracranianas associadas à doença de Graves [35][36][37] . Quanto ao achado de tireotoxicose e dissecção carotídea bilateral em duas pacientes da nossa série, não encontramos referências específicas sobre essa possível relação.…”

Section: Discussionunclassified

Dissecção espontânea cervical carotídea e verbal: estudo de 48 pacientes

Campos

Evaristo

Yamamoto

et al. 2004

Arq. Neuro-Psiquiatr.

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, Milberto Scaff 4 RESUMO -Objetivo: Dada a ausência de estudos de séries brasileiras de pacientes com dissecção arterial cervical espontânea, com o objetivo de descrever os fatores de risco, sintomas precedentes, manifestações clínicas, resultados da investigação, tratamento e evolução. Método: realizamos a análise retrospectiva dos prontuários e laudos radiológicos [angiografia digital(AD), ressonância magnética(RM) e ângio-ressonância(ARM)] dos pacientes com esse diagnóstico atendidos no Serviço de Neurologia do HC/USP entre 1997 e 2003. Resultados: 48 pacientes (24 homens), média de idade 37,9 anos; 26 pacientes com dissecção carotídea (DC) unilateral, 15 com vertebral (DV) unilateral e 7 com multiarterial, todos com déficits neurológicos. Os principais fatores de risco para doença vascular foram hipertensão arterial, tabagismo e dislipidemia. Mais de 80% apresentaram pelo menos um sintoma precedente, na maioria cefaléia têmporo-parietal. Cervicalgia foi referida por 44% dos pacientes com DV e por 3,4% dos com DC. O tempo médio entre o primeiro sintoma e o déficit foi 5,4 dias para as DC e 13,5 para as DV.AD foi o principal método diagnóstico (93%), associado a RM e ARM em 42% dos casos. Em 3 pacientes a RM cervical com supressão de gordura foi isoladamente suficiente. 75% dos pacientes receberam anticoagulação. Dois pacientes fizeram trombólise endovenosa sem complicações. A evolução foi boa, exceto por dois óbitos (DC bilateral). Conclusão: Os resultados são semelhantes aos da literatura, exceto pela baixa freqüência de cervicalgia nos casos de DC e pelo predomínio de cefaléia têmporo-parietal nas dissecções arteriais cervicais. Fatores de risco para doença vascular isquêmica foram frequentes. PALAVRAS-CHAVE: dissecção arterial, artéria carótida interna, artéria vertebral, angiografia, ressonância magnética. Spontaneous cervical carotid and vertebral arteries dissection -Study of 48 patientsABSTRACT -Objective: To report a Brazilian series of spontaneous cervical arterial dissections, risk factors, warning symptoms, clinical manifestations, diagnostic tests, treatment and prognosis. Method: We performed the retrospective analysis of clinical and neuroradiological records (MRI, A-MRI and Angiography) of patients with this diagnosis who were evaluated in a tertiary hospital for the period of 1997-2003. Results: 48 patients (24 men) with median age 37.9 years: 26 patients with unilateral internal carotid dissection (ICAD), 15 with unilateral vertebral artery dissection (VAD) and 7 with multivessel dissections. All patients presented neurological deficits. Hypertension, smoking and dyslipidemia were the main risk factors. More than 80% of patients presented at least one initial symptom, most of them temporoparietal headache. 44% of patients with VAD and only 3.4% of patients with ICAD had neck pain. The median interval between the onset of symptom and the appearance of neurological deficit was 5.4 days for ICAD and 13.5 days for VAD. Five patients with ICAD presented preceding TIA. Angiography was performed in...

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“…17,19) In addition to these mechanical vascular abnormalities, excessive thyroid hormones may affect cerebral metabolism, cerebral oxygen consumption, cerebral hemodynamics, and cerebrovascular autoregulation, which may be triggers of the cerebral ischemic event. 7,9,10,19) The effectiveness of simple antithyroid therapy for cerebral ischemic symptoms might indirectly prove these mechanisms. Further study is required to obtain more evidence of the relationship between genetic and immunogenic backgrounds for these associated conditions.…”

Section: Discussionmentioning

confidence: 99%

“…17) Several cases have been reported of the coexistence of moyamoya vasculopathy and Graves' disease, which is a femaledominant autoimmune thyroid disease causing hyperthyroidism. [5][6][7]9,10,12,13,16,[19][20][21] Surgical revascularization for moyamoya disease prevents cerebral ischemic events by improving cerebral blood flow (CBF), and superficial temporal arterymiddle cerebral artery (STA-MCA) anastomosis with or without indirect pial synangiosis is generally used as the standard surgical treatment. 1) Application of this revascularization surgery to the treatment of moyamoya syndrome associated with Graves' disease is still undetermined because of the rarity of this combination.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Revascularization Surgery for Moyamoya Syndrome Associated With Graves' Disease

Endo

Fujimura

Niizuma

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Appropriate management of moyamoya syndrome associated with Graves' disease is undetermined because of the rarity of this combination. Patients tend to present with cerebrovascular events such as transient ischemic attack (TIA) in a thyrotoxic state, which is relieved by proper antithyroid therapy. Four patients with moyamoya syndrome associated with Graves' disease were successfully treated with revascularization surgery on 5 hemispheres among 58 consecutive patients (2-62 years old, mean 34.4 years) with moyamoya disease in 80 hemispheres treated from March 2004 to May 2007. Three patients presented with TIA, and one patient presented with intracerebral hemorrhage. Three patients were thyrotoxic at the onset of the cerebrovascular events. All patients underwent revascularization surgery after normalization of thyroid function. Euthyroid state was strictly maintained perioperatively. One patient developed symptomatic cerebral hyperperfusion, which was resolved by blood pressure control. Postoperative courses of the other patients were uneventful, and all 4 patients have remained neurologically stable after discharge. Cerebrovascular reconstruction surgery is a successful treatment option for moyamoya syndrome associated with Graves' disease. Timing of surgery during the euthyroid state and perioperative management considering the thyroid function and the cerebral hemodynamic change are the keys to successful surgical treatment.

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Graves' Thyrotoxicosis and Moyamoya Disease

Cited by 46 publications

References 4 publications

Improvement of Cerebral Arterial Stenosis Associated With Basedow's Disease-Case Report-

Improvement of Cerebral Arterial Stenosis Associated With Basedow's Disease-Case Report-

Dissecção espontânea cervical carotídea e verbal: estudo de 48 pacientes

Efficacy of Revascularization Surgery for Moyamoya Syndrome Associated With Graves' Disease

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