Familial Presentation of Intracranial Occlusive Arteriopathy and Ischemic Stroke in Patients with Graves’ Hyperthyroidism

Abstract

Background:The comorbidity of intracranial occlusive arteriopathy and Graves’ disease (GD) is increasingly being reported.Methods:We describe two patients (mother and daughter) with GD, intracranial occlusive arteriopathy, and ischemic strokes.Results:Both patients were thyrotoxic at the time of the ischemic event, and the intracranial arterial stenosis was progressive while in thyrotoxic state. In one of the cases, there was no further progression of the disease after 1 year of follow up, once hyperthyroidism was well controlled.Conclusion:To the best of our knowledge, this is the first report of familial presentation of moyamoya-like vasculopathy in patients with GD in Latin population.

A case of acute ischemic stroke in moyamoya syndrome associated with Graves’ disease: Is there a role for anti-dsDNA antibodies?

“…MMS associated with GD mostly occurs in adult female patients. Their clinical symptoms are mainly ischemic lesions and usually occur during the state of hyperthyroidism [4,5,[7][8][9][10][11]. The predominance of the female sex probably reflects the epidemiology of GD.…”

“…Although there are many case reports and few studies [4][5][6][7][8][9][10][11][12][13][14][15][16]11,18,19] have mentioned the relationship between MMS and GD, it is not clear whether this relationship is coincidental or causal, since the pathoetiological link has not yet been elucidated and, therefore, the mechanism of MMS and its relation to GD will remain a matter of debate. Despite this, various mechanisms have been postulated, suggesting genetic and autoimmune factors as important players in the pathogenesis of MMS in association with GD [20][21][22].…”

“…MMS associated with GD is assumed to be rarely reported; however, this clinical entity has been described increasingly in scientific literature in the past few years [4][5][6][7][8][9][10][11][12][13][14][15][16]. In this report, we present a case of acute cerebral infarction in a patient with MMS, which appeared to be aggravated by thyrotoxicosis.…”

“…Conventionally, GD is characterized by hyperthyroidism, diffuse goiter, ophthalmopathy, and dermatopathy. Additional tests such as antibodies to thyroglobulin, thyroid peroxidase, and the TSH receptor provide evidence supporting GD rather than confirming the diagnosis [3,4].…”