J Korean Endocr Soc.  2008 Feb;23(1):51-55. 10.3803/jkes.2008.23.1.51.

A Case of Unilateral Exophthalmos Caused by a Dural Arteriovenous Malformation in Thyroid-Associated Ophthalmopathy

• Choi SR
• Lee SJ
• Lee HR
• Kang JG
• Ryu OH
• Kim CS
• Lee BW
• Hong EG
• Kim HK
• Kim DM
• Yoo JM
• Ihm SH
• Choi MG
• Yoo HJ

• KMID: 2063550
• DOI: http://doi.org/10.3803/jkes.2008.23.1.51

Abstract

Thyroid-associated ophthalmopathy is associated with thyroid dysfunction, particularly Graves' disease, and is manifested as eye signs, including proptosis. In cases of unilateral exophthalmos with thyroid-associated ophthalmopathy, other causes such as orbital neoplasm, carotid-cavernous fistula, cavernous sinus thrombosis, and dural arteriovenous malformation (AVM) should be excluded. Dural AVM, an abnormal dural arteriovenous connection, is a rare neurovascular entity that mimics thyroid-associated ophthalmopathy. When eye involvement is unilateral or asymmetric, dural AVM can be considered in the differential diagnosis of thyroid-associated ophthalmopathy. A twenty-six year-old woman presented with unilateral exophthalmos in Graves' disease. By orbital magnetic resonance imaging and cerebral angiography, thyroid-associated ophthalmopathy and dural AVM were diagnosed. The unilateral exophthalmos improved after coil embolization of the dural AVM. In summary, we report the first case of a dural AVM with Graves' disease and thyroid-associated ophthalmopathy.

Keyword

dural arteriovenous malformation; exophthalmos; thyroid-associated ophthalmopathy

MeSH Terms

Arteriovenous Malformations
Cavernous Sinus Thrombosis
Cerebral Angiography
Diagnosis, Differential
Exophthalmos
Eye
Female
Fistula
Graves Disease
Graves Ophthalmopathy
Humans
Magnetic Resonance Imaging
Orbit
Orbital Neoplasms
Thyroid Gland

Figure

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  Fig. 1 Orbital MRI. Right exophthalmos, both extraocular muscle thickening and right retro-orbital vessel engorgement (arrow) are seen.

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  Fig. 2 Cerebral angiography reveals dural arteriovenous malformation (AVM) without cortical venous reflex, so called type I AVM (arrows).

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  Fig. 3 After selection of dural AVM, coil embolization was performed in abnormal vessel.

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