J Neurocrit Care.  2018 Dec;11(2):129-133. 10.18700/jnc.180046.

Acute Ischemic Stroke in Moyamoya Syndrome Associated with Thyrotoxicosis

• Kang D
• Seong GH
• Bae JS
• Lee JH
• Song HK
• Kim Y

• KMID: 2434840
• DOI: http://doi.org/10.18700/jnc.180046

Abstract

BACKGROUND
A few cases of moyamoya syndrome associated with thyrotoxicosis have been reported. However, studies on the association of hyperthyroidism with moyamoya syndrome are insufficient.
CASE REPORT
Here we report a case of hyperthyroidism associated with moyamoya syndrome in a 41-year-old woman with aphasia and right side weakness. Brain imaging revealed acute cerebral infarction of left middle cerebral artery territory and occlusion of bilateral distal internal carotid arteries.
CONCLUSION
Antithyroid medication stabilized the patient's neurologic deterioration, suggesting that thyrotoxicosis could aggravate acute cerebral infarction caused by moyamoya syndrome.

Keyword

Moyamoya disease; Thyrotoxicosis; Cerebral infarction

MeSH Terms

Adult
Aphasia
Carotid Artery, Internal
Cerebral Infarction
Female
Humans
Hyperthyroidism
Middle Cerebral Artery
Moyamoya Disease*
Neuroimaging
Stroke*
Thyrotoxicosis*

Figure

• 

  Figure 1. Brain DWI, ADC, T1WI with gadolinium enhancement, FLAIR images, and head and neck MR angiographic images (A-F). DWI shows acute cerebral infarction on left middle cerebral artery territory (A) with low signal on ADC (B). T1WI images with gadolinium enhancement reveals prominent leptomeningeal enhancement in bilateral hemispheres (black arrows, C). FLAIR images show high signal intensity in the same area (black arrows, D). MR angiographic imaging reveals total occlusion of bilateral distal internal carotid arteries (E, F). DWI, diffusion-weight imaging; ADC, apparent diffusion coefficient; T1WI, T1-weighted images; FLAIR, fluidattenuated inversion recovery; MR, magnetic resonance.

• 

  Figure 2. Brain single photon emission computed tomography (A-D). Odd lines show basal imaging and even lines show post-zoladin imaging. These imaging confirmed decreased perfusion and collateral blood reservoir lacking in left frontotemporal lobe and right temporal lobe.

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