Int J Thyroidol.  2017 May;10(1):56-60. 10.11106/ijt.2017.10.1.56.

A Case of Acute Cerebral Infarction and Thyroid Storm Associated with Moyamoya Disease

• Jang SA
• Baek YH
• Park TS
• Lee KA

• KMID: 2379363
• DOI: http://doi.org/10.11106/ijt.2017.10.1.56

Abstract

Coexistence of moyamoya disease and Graves' disease is rare. A 41-year-old woman presented with symptoms of left-sided hemiparesis and dysarthria. Magnetic resonance imaging and angiography revealed acute infarction of the right thalamus and occipital lobe with complete obstruction of the distal internal carotid arteries and obstruction of the right P2. Free thyroxine, thyroid-stimulating hormone (TSH), and TSH receptor antibody levels were 79.33 pmol/L, 0.007 uIU/mL, and 151.5 u/L, respectively. She received antiplatelet therapy and standard antithyroid drug dose. After admission, seizure and unexplained fever occurred. The thyroid storm score (Burch and Wartofsky scale) was 90 points. After intensive treatment, mental status and thyrotoxicosis-related symptoms ameliorated and vital signs stabilized. We describe a case of thyroid storm following cerebrovascular ischemic events in a Korean woman with moyamoya disease and Graves' disease. Thyroid storm combined with cerebrovascular events can lead to severe morbidity and mortality. Prompt recognition and strict management are crucial.

Keyword

Moyamoya disease; Graves' disease; Thyroid storm

MeSH Terms

Adult
Angiography
Carotid Artery, Internal
Cerebral Infarction*
Dysarthria
Female
Fever
Graves Disease
Humans
Infarction
Magnetic Resonance Imaging
Mortality
Moyamoya Disease*
Occipital Lobe
Paresis
Receptors, Thyrotropin
Seizures
Thalamus
Thyroid Crisis*
Thyroid Gland*
Thyrotropin
Thyroxine
Vital Signs
Receptors, Thyrotropin
Thyrotropin
Thyroxine

Figure

• 

  Fig. 1 Brain magnetic resonance of T2 FLAIR axial image, diffusion-weighted image and brain MR angiography maximum intensity projection showing acute infarction of the right thalamus and occipital lobe.

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  Fig. 2 Cerebral angiograms showing complete obstruction of both distal internal carotid arteries.

• 

  Fig. 3 99m Technetium pertechnetate scintigraphy scan showing an enlarged thyroid with diffusely increased uptake.

• 

  Fig. 4 Electrocardiography reveal atrial fibrillation with a rapid ventricular response.

• 

  Fig. 5 Plain chest radiograph showing cardiomegaly.

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