scholarly journals Moyamoya syndrome associated with Graves’ disease

Nosotchu ◽  
2012 ◽  
Vol 34 (2) ◽  
pp. 82-88 ◽  
Author(s):  
Takeshi Mikami ◽  
Toshiya Sugino ◽  
Aya Kanno ◽  
Kiyohiro Houkin ◽  
Nobuhiro Mikuni
Keyword(s):  
Graves Disease ◽  
Moyamoya Syndrome

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

2010 ◽  
Vol 50 (11) ◽  
pp. 977-983 ◽  
Author(s):  
Hidenori ENDO ◽  
Miki FUJIMURA ◽  
Kuniyasu NIIZUMA ◽  
Hiroaki SHIMIZU ◽  
Teiji TOMINAGA
Keyword(s):  
Graves Disease ◽  
Moyamoya Syndrome ◽  
Revascularization Surgery

Reversible chorea in association with Graves' disease and moyamoya syndrome

2008 ◽  
Vol 23 (4) ◽  
pp. 620-622 ◽  
Author(s):  
Béatrice Garcin ◽  
Taina Louissaint ◽  
Hassan Hosseini ◽  
Raphaël Blanc ◽  
Gilles Fénelon
Keyword(s):  
Graves Disease ◽  
Moyamoya Syndrome

scholarly journals Fatal outcome in a Hispanic woman with moyamoya syndrome and Graves’ disease

2016 ◽  
Vol 2016 ◽  
Author(s):  
Julian Choi ◽  
Perin Suthakar ◽  
Farbod Farmand
Keyword(s):  
Thyroid Function ◽  
Fatal Outcome ◽  
Graves Disease ◽  
List Type ◽  
Moyamoya Syndrome ◽  
Perioperative Mortality ◽  
Mortality And Morbidity ◽  
Post Operative Period ◽  
Revascularization Surgery ◽  
Learning Points

Summary We describe the case of a young Hispanic female who presented with thyrotoxicosis with seizures and ischemic stroke. She was diagnosed with a rare vasculopathy – moyamoya syndrome. After starting antithyroid therapy, her neurologic symptoms did not improve. Acute neurosurgical intervention had relieved her symptoms in the immediate post-operative period after re-anastomosis surgery. However, 2 post-operative days later, she was found to be in status epilepticus and in hyperthyroid state. She quickly deteriorated clinically and had expired a few days afterward. This is the second case in literature of a fatality in a patient with moyamoya syndrome and Graves’ disease. However, unlike the other case report, our patient had undergone successful revascularization surgery. We believe her underlying non-euthyroid state had potentiated her clinical deterioration. Case studies have shown positive correlation between uncontrolled hyperthyroidism and stroke-like symptoms in moyamoya syndrome. Mostly all patients with these two disease processes become symptomatic in marked hyperthyroid states. Thus, it may be either fluctuations in baseline thyroid function or thyrotoxicosis that potentiate otherwise asymptomatic moyamoya vasculopathy. Learning points: Awareness of the association between Graves’ disease and moyamoya syndrome in younger patients presenting with stroke-like symptoms. Obtaining euthyroid states before undergoing revascularization surgery may protect the patient from perioperative mortality and morbidity. Although moyamoya disease is usually thought to be genetically associated, there are reports that thyroid antibodies may play a role in its pathogenesis and have an autoimmune link. Fluctuations in baseline thyroid function for patients with known Graves’ disease may be a potentiating factor in exacerbating moyamoya vasculopathy.

Moyamoya Syndrome Associated with Graves' Disease: A Case Report and Review of the Literature

2011 ◽  
Vol 20 (6) ◽  
pp. 528-536 ◽  
Author(s):  
Shaneela Malik ◽  
Andrew N. Russman ◽  
Angelos M. Katramados ◽  
Brian Silver ◽  
Panayiotis D. Mitsias
Keyword(s):  
Case Report ◽  
Graves Disease ◽  
Moyamoya Syndrome ◽  
Review Of The Literature

Abstract 2786: Moyamoya Syndrome Associated With Graves' Disease: Report Of 16 Cases

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jun NI ◽  
Li-xin ZHOU ◽  
Yan-ping WEI ◽  
Lian DUAN ◽  
Shan GAO ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Arteries ◽  
Laboratory Data ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Moyamoya Syndrome ◽  
College Hospital ◽  
Ischemic Attack ◽  
Collateral Vessels

Background and purpose Moyamoya disease is a cerebrovascular disorder characterized by bilateral progressive stenosis and occlusion of terminal portions of internal carotid artery (ICA) accompanying by typical net-like collateral vessels. Patients with both the characteristic moyamoya vasculopathy and the associated conditions are categorized as moyamoya syndrome. These conditions include sickle cell disease, neurofibromatosis type 1, Down’s disease, cranial therapeutic irradiation and other rare diseases. Moyamoya syndrome associated with Graves’ disease has been rarely reported and the underlying coexisting mechanism remains unclear. The aim of this study is to identify the clinical and radiological findings of the patients with simultaneous diagnosis of moyamoya syndrome and Graves’ disease. Possible mechanisms predisposing these individuals to ischemic accidents are discussed. Methods We retrospectively identified 12 patients in Peking Union Medical College Hospital and 4 patients in 307 hospital of PLA between May 2000 and December 2010. All patients were female and mean age (range) was 35.13±12.34 years (11-57 years). The patients were diagnosed with Graves’ disease in endocrinology clinic which meet the full diagnostic criteria and no atherosclerotic factor was found in them. Moyamoya vasculopathy was definitely or probably diagnosed by digital subtract angiography or magnetic resonance angiography. The clinical characteristics and prognosis, laboratory data, vascular radiological characteristics were all collected. Results Stenosis or occlusion of bilateral distal ICA and/or proximal anterior /middle cerebral arteries was found in 13 patients. Three patients had unilateral distal ICA stenosis and abnormal collateral vessels. PCA stenosis was found in 2 patients. Fifteen patients presented with infarction or transient ischemic attack and one with dizziness. Interestingly, thyroid function tests demonstrated predominantly elevated thyroxine and suppressed thyroid stimulating hormone level in 15 patients when cerebrovascular accidents occurred. All patients received antithyroid therapy and two had recurrent ischemic attack after several months of drug withdrawal. Four patients underwent revascularization procedures after normalization of their hormonal conditions in 307 Hospital of PLA and their neurologic status has remained stable during follow-up. Conclusions: Compared with classical moyamoya disease, moyamoya syndrome associated Graves’ disease more commonly presented asymmetric stenosis or occlusion and PCA lesions. Cerebrovascular hemodynamic changes attributable to thyrotoxicosis might be responsible for ischemic attack and further studies are required to verify this hypothesis.

scholarly journals A Grave Initial Presentation of Graves’ Disease in a Patient With Moyamoya

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A913-A913
Author(s):  
Courtney Clutter ◽  
Morgan Jordan
Keyword(s):  
Ischemic Stroke ◽  
Moyamoya Disease ◽  
Multinodular Goiter ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Graves Disease ◽  
Moyamoya Syndrome ◽  
The Right ◽  
Internal Carotid Arteries ◽  
The U.S

Abstract Background: Moyamoya syndrome is chronic stenoocclusive disease involving the intracranial internal carotid arteries and their proximal branches along with an associated condition, such as hyperthyroidism1. The concurrence of moyamoya and Graves’ disease is rare. Ischemic stroke in moyamoya syndrome is postulated to be precipitated by thyrotoxicosis-induced hemodynamic instability. Clinical Case: A 63-year old Korean female with history of moyamoya disease with two prior ischemic strokes, hypertension and type 2 diabetes mellitus presented to the ER with 6 hours of left leg weakness and involuntary arm movements. A code stroke was activated and neurologic examination was notable for left leg paresis and left arm stereotypy. CT head showed loss of gray-white matter differentiation in the right frontal lobe concerning for acute ischemia. CT angiography of the head and neck noted diffuse stenosis of intracerebral vasculature and significant stenosis of the cavernous and supraclinoid portions of the internal carotid arteries. MRI brain later confirmed an acute infarct in the right ACA distribution. Neuroimaging incidentally showed a multinodular goiter with a 1.7 cm right thyroid nodule. Subsequently TSH was obtained and resulted as <0.030 mcIU/mL (0.27-5.00 mcIU/mL) with a reflex FT4 of >7.00 ng/dL (0.6-1.8 ng/dL). A review of her prior TFTs showed biochemical euthyroidism. Due to iodinated contrast administration on admission, RAIU scan was deferred. Thyroid ultrasound showed multinodular goiter with diffuse increased vascularity and multiple TI-RADS 4 and 5 nodules bilaterally. On further questioning, the patient reported tachycardia, diarrhea, weight loss and decreased appetite prior to hospitalization. A diagnosis of Graves’ disease was confirmed with TSI of 70.7 IU/L (0.00-0.55 IU/L). She was started on methimazole 20 mg twice daily and propranolol 20 mg q6h. FT4 downtrend from >7.00 to 3.3 ng/dL at time of discharge. Following four weeks of methimazole 20 mg daily, FT4 normalized to 1.70 ng/dL. The patient chose to continue antithyroidal drug therapy for treatment of Graves’ disease. Conclusion: Thyroid function assessment should be considered when evaluating a patient with moyamoya and acute ischemic stroke. If moyamoya syndrome associated with Graves’ disease is identified, treatment should be aimed at maintenance of euthyroidism. Reference: 1. Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med. 2009 Mar 19;360(12):1226-37. Disclaimer: The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force and Department of Defense or the U.S. Government.

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