Coexistence of moyamoya and Graves’ diseases: The clinical characteristics and treatment effects of 21 Chinese patients

Li, Desheng; Yang, Wei-Zhong; Xian, Peng; Liu, Peng; Bao, Xu; Zong, Rui; Duan, Lian

doi:10.1016/j.clineuro.2013.02.018

Cited by 19 publications

(20 citation statements)

References 40 publications

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“…MMD concurrent with GD is rare [12,16,18,27]. While MMD is known to manifest ischemic and/or hemorrhagic symptoms [22], no hemorrhagic event was reported in MMD concurrent with GD.…”

Section: Discussionmentioning

confidence: 97%

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Moyamoya disease concurrent with Graves’ disease treated by direct bypass: clinical features and treatment strategies

et al. 2015

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“…MMD concurrent with GD is rare [12,16,18,27]. While MMD is known to manifest ischemic and/or hemorrhagic symptoms [22], no hemorrhagic event was reported in MMD concurrent with GD.…”

Section: Discussionmentioning

confidence: 97%

“…One of these concurrent diseases is Graves' disease (GD), which is an autoimmune disease. MMD associated with GD is rare [12,16,18,27]. MMD and GD have been suggested to have similar pathogenesis because elevated thyroid autoantibodies were frequently observed in MMD patients without GD [9].…”

Section: Introductionmentioning

confidence: 97%

Moyamoya disease concurrent with Graves’ disease treated by direct bypass: clinical features and treatment strategies

et al. 2015

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“…There are reports of elevated levels of thyroid antibodies detected in some patients presenting with signs of ischemia secondary to moyamoya disease, even without impaired thyroid functionality (3). Given the increased presence of T-cells within affected vessels, the possibility for T-cell-mediated cross-reactivity between TSH receptor antibodies, and antigens within the cerebral arteries, as well as impaired T-cell function may be a common pathogenetic factor in both diseases (4, 5, 6, 7). Colleran et al (8) has elicited a positive correlation between elevated thyroxine levels with increased homocysteine and methylmalonic acid levels.…”

Section: Discussionmentioning

confidence: 99%

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

Choi¹,

Suthakar

Farmand³

2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryWe 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.

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“…One patient had Graves' disease, which has been associated with MMS. 13 Interestingly, there were a number of patients who had headache disorders (32%) or psychiatric conditions (24%) associated with moyamoya.…”

Section: Resultsmentioning

confidence: 99%

Surgical outcomes following encephaloduroarteriosynangiosis in North American adults with moyamoya

Agarwalla

Stapleton

Phillips

et al. 2014

JNS

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Object. Moyamoya disease/syndrome (MMD/S) is a progressive, occlusive vasculopathy of the intracranial vasculature that leads to ischemic and hemorrhagic strokes. Significant debate exists regarding the role of indirect cerebrovascular bypass surgery in its management. The authors review their institution's experience with indirect bypass in the surgical management of patients with MMD/S.Methods. The authors conducted a retrospective review of patients with MMD/S who underwent encephaloduroarteriosynangiosis (EDAS), a form of indirect bypass, from 1996 to 2013.Results. A total of 37 patients (52 hemispheres) underwent an EDAS procedure for MMD/S; 21 patients received revascularization of both hemispheres. Patients presented with the following: 49% with stroke, 35% with transient ischemic attack, 13% with hemorrhage, and 3% with seizure. The mean Suzuki grade was 3.46. The number of patients with a modified Rankin Scale score of 0-1 improved from 21 to 29 (p = 0.002) from the time of surgery to the time of last follow-up. The number of neurological events (i.e., transient ischemic attacks, strokes, and hemorrhages) decreased from a mean of 1.7 events per patient to 0.14 (p < 0.001). The mean length of follow-up was 32.8 months.Conclusions. This series demonstrates that EDAS is an effective procedure for MMD/S in a North American cohort of patients. (http://thejns.org/doi/abs/10.3171/2014.8.JNS132176) key worDs • bypass • EDAS • hemorrhage • moyamoya • stroke • vascular disordersAbbreviations used in this paper: ECA = external carotid artery; EDAS = encephaloduroarteriosynangiosis; ICA = internal carotid artery; LOS = length of stay; MCA = middle cerebral artery; MMD = moyamoya disease; MMD/S = moyamoya disease/syndrome; MMS = moyamoya syndrome; mRS = modified Rankin Scale; STA = superficial temporal artery; STL = superior temporal line; TIA = transient ischemic attack.* Drs. Agarwalla and Stapleton contributed equally to this work.

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Coexistence of moyamoya and Graves’ diseases: The clinical characteristics and treatment effects of 21 Chinese patients

Cited by 19 publications

References 40 publications

Moyamoya disease concurrent with Graves’ disease treated by direct bypass: clinical features and treatment strategies

Moyamoya disease concurrent with Graves’ disease treated by direct bypass: clinical features and treatment strategies

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

Surgical outcomes following encephaloduroarteriosynangiosis in North American adults with moyamoya

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