Severe Cerebral Vasospasm in Patients with Hyperthyroidism

Abstract

Cerebral vasospasm associated with hyperthyroidism has not been reported to cause cerebral infarction. The case reported here is therefore the first of cerebral infarction co-existing with severe vasospasm and hyperthyroidism. A 30-year-old woman was transferred to our hospital in a stuporous state with right hemiparesis. At first, she complained of headache and dizziness. However, she had no neurological deficits or radiological abnormalities. She was diagnosed with hyperthyroidism 2 months ago, but she had discontinued the antithyroid medication herself three days ago. Magnetic resonance imaging and angiography showed cerebral infarction with severe vasospasm. Thus, chemical angioplasty using verapamil was performed two times, and antithyroid medication was administered. Follow-up angiography performed at 6 weeks demonstrated complete recovery of the vasospasm. At the 2-year clinical follow-up, she was alert with mild weakness and cortical blindness. Hyperthyroidism may influence cerebral vascular hemodynamics. Therefore, a sudden increase in the thyroid hormone levels in the clinical setting should be avoided to prevent cerebrovascular accidents. When neurological deterioration is noticed without primary cerebral parenchyma lesions, evaluation of thyroid function may be required before the symptoms occur.

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

“…In case 4, the patient was treated via angioplasty using verapamil during the acute phase of ischemic stroke, and improvement in MMV to some extent was observed. Moreover, the patient completely recovered after 6 weeks [7]. This case shows that Bas-MMV might be at least partially caused by vasospasm.…”

“…Table 1 shows a summary of 6 case reports [4][5][6][7][8][9] which showed improvement in Bas-MMV during the clinical course. Three patients (cases 1-3) and the patient in this case report were treated with an antithyroid drug [4][5][6], and 1 patient (case 4) was treated with an antithyroid drug and angioplasty [7]. The remaining 2 patients (cases 5 and 6) were treated with antithyroid and immunosuppressive agents [8,9].…”

“…The pathogenesis of Bas-MMV is not fully understood; however, some mechanisms are associated with this condition. Numerous case reports of coronary artery spasm in Basedow disease are available [10], and the study by Oh et al [7] has shown that Bas-MMV can also be caused at least in part by vasospasm. It is hypothesized that the activation of sympathetic nerves through hyperthyroidism induces vasospasm.…”

An extensive posterior circulation infarction secondary to primary hyperthyroidism accompanied with superior mesenteric artery syndrome

“…[ 2 ] Hyperthyroidism could be associated with stroke through mechanisms including atrial fibrillation-related embolism, moyamoya syndrome (MMS), vasculopathy, and vasospasm. [ 2 – 5 ] Moyamoya syndrome is characterized by progressive stenosis and occlusion of bilateral or unilateral terminal portions of internal carotid artery with associated causative systemic conditions. [ 6 – 8 ] Despite rarely the cause of MMS, the association between GD and MMS has been well documented.…”