Concurrence of Graves' Disease and Dysplastic Cerebral Blood Vessels of the Moyamoya Variety

Tendler, Beatriz; Shoukri, Kamal; Malchoff, Carl D.; MacGillivray, Dougald C.; Duckrow, Robert B.; Talmadge, Todd; Ramsby, Gale R.

doi:10.1089/thy.1997.7.625

Cited by 58 publications

(45 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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: 75%

“…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%

See 1 more Smart Citation

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

Yamashita

Tamiya

Shindo

et al. 2005

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

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.

show abstract

Section: Case Reportmentioning

confidence: 75%

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)

View full text Add to dashboard Cite

show abstract

“…Previous reports suggested that T-cell dysregulation and special immunological stimulation conditions (e.g., autoimmune thyroid disease) may relate to cellular proliferation and vascular dysregulation in MMD. 13,16,20 Several studies have suggested that an association exists between MMD and autoimmune diseases, including Type 1 diabetes mellitus, AIG, SLE, APAS, APS, PBC, GD, and HT. 2,7,15,17,18,20,22,23,25 Furthermore, several reports have demonstrated that thyroid autoantibodies may be associated with the moyamoya development.…”

Section: Discussionmentioning

confidence: 99%

“…13,16,20 Several studies have suggested that an association exists between MMD and autoimmune diseases, including Type 1 diabetes mellitus, AIG, SLE, APAS, APS, PBC, GD, and HT. 2,7,15,17,18,20,22,23,25 Furthermore, several reports have demonstrated that thyroid autoantibodies may be associated with the moyamoya development. 13,15,16 Our study also indicated that autoimmune abnormalities may be associated with pathophysiological mechanisms of moyamoya vasculopathy formation.…”

Section: Discussionmentioning

confidence: 99%

Increased prevalence of autoimmune disease in patients with unilateral compared with bilateral moyamoya disease

Chen

Liu

Zhou

et al. 2016

JNS

View full text Add to dashboard Cite

M oyamoya vasculopathy (MMV) is a disorder that is characterized by stenosis or occlusion of the terminal internal carotid artery (ICA) and the proximal portion of the anterior and/or middle cerebral arteries. Additionally, it is accompanied by net-like collateral vessel formations, which are termed the "moyamoya" vessels.14,18 Moyamoya disease (MMD) is defined by the presence of bilateral MMV with an unknown etiology or the presence of unilateral MMV at 1 side with obvious terminal contralateral ICA stenosis.4 Unilateral MMD is defined by typical angiographic evidence of MMD unilaterally with normal or equivocal contralateral findings. 4The concept that unilateral MMD is an early form of bilateral MMD remains controversial, and the pathogenesis of moyamoya disorders is not fully understood. 7,11,14,18 MMD has been reportedly associated with various entities. 2,8,9,13,16,24 Analysis of the coexisting diseases that occur with moyamoya may be helpful in exploring moyamoya pathogeneses. Several reports have noted MMD in association with autoimmune diseases, including autoim- obJective This study explored whether there were differences between the autoimmune disease prevalence rates in unilateral and bilateral moyamoya disease (MMD). methods The authors performed a retrospective review of data obtained from the medical records of their hospital, analyzing and comparing the clinical characteristics and prevalence rates of all autoimmune diseases that were associated with unilateral and bilateral MMD in their hospital from January 1995 to October 2014. results Three hundred sixteen patients with bilateral MMD and 68 with unilateral MMD were identified. The results indicated that patients with unilateral MMD were more likely to be female than were patients with bilateral MMD (67.6% vs 51.3%, p = 0.014, odds ratio [OR] 1.99). Overall, non-autoimmune comorbidities tended to be more prevalent in the unilateral MMD cases than in the bilateral MMD cases (17.6% vs 9.8%, p = 0.063, OR 1.97, chi-square test). Autoimmune thyroid disease and other autoimmune diseases also tended to be more prevalent in the unilateral MMD cases than in the bilateral MMD cases (19.1% vs 10.8%, p = 0.056, OR 1.96 and 8.8% vs 3.5%, p = 0.092, OR 2.77, respectively, chi-square test). The overall autoimmune disease prevalence in the unilateral MMD cases was significantly higher than in the bilateral MMD cases (26.5% vs 13.6%, p = 0.008, OR 2.29, 95% CI 1.22-4.28, chi-square test). Multiple logistic regression analysis showed that autoimmune disease was more likely to be associated with unilateral than with bilateral MMD (p = 0.039, OR 10.91, 95% CI 1. 13-105.25). coNclusioNs This study indicated a higher overall autoimmune disease prevalence in unilateral than in bilateral MMD. Unilateral MMD may be more associated with autoimmune disease than bilateral MMD. Different pathogenetic mechanisms may underlie moyamoya vessel formation in unilateral and bilateral MMD.

show abstract

“…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)

View full text Add to dashboard Cite

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.

show abstract

Concurrence of Graves' Disease and Dysplastic Cerebral Blood Vessels of the Moyamoya Variety

Cited by 58 publications

References 30 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-

Increased prevalence of autoimmune disease in patients with unilateral compared with bilateral moyamoya disease

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

Contact Info

Product

Resources

About