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Case Reports
. 2020 May 20;12(2):140-147.
doi: 10.1159/000502571. eCollection 2020 May-Aug.

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

Masaoki Hidaka  1 , Masato Osaki  1 , Shinya Yamaguchi  2 , Tetsuro Sayama  2 , Shuji Arakawa  1 , Takanari Kitazono  3
Affiliations
Case Reports

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

Masaoki Hidaka et al. Case Rep Neurol. .

Abstract

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 progressed. Then, MMV improved again with the normalization of her thyroid function. This case shows that MMV associated with Basedow disease could worsen or improve depending on the thyroid hormone status.

Keywords: Basedow disease; Ischemic stroke; Moyamoya vasculopathy; Quasi-moyamoya disease; Thyrotoxicosis.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Magnetic resonance imaging (MRI) and single-photon emission tomography (SPECT) findings during the initial stroke. a MRI showed cerebral infarctions in the right frontal and parietal lobes. b Left: magnetic resonance angiography revealed stenosis of the proximal portions of the bilateral middle cerebral arteries (MCAs) and the terminal portions of the bilateral internal carotid arteries. Right: SPECT showed decreased cerebral blood flow in the right MCA territory.
Fig. 2
Fig. 2
Brain magnetic resonance angiography (MRA) during the clinical course. a Initial MRA revealed stenosis in the proximal portions of the bilateral middle cerebral arteries (MCAs). b Two months later, bilateral MCA stenosis improved to some extent. c Four months later, further improvement was observed. d Six months later, the patient developed transient left hemiparesis, and slight re-stenosis of MCAs was observed. e Seven months later, a week after the patient had become euthyroid, bilateral MCA stenosis worsened. f Nine months later, bilateral MCA stenosis improved again.
Fig. 3
Fig. 3
High-resolution, black-blood fat-suppressed pre-contrast T1-weighted images 7 months after the initial stroke (1 month after the 2nd ischemic event). a, b Long and short axial images revealing the absence of thickening in the vessel wall of the stenosed middle cerebral arteries.
See this image and copyright information in PMC

References

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