Coexistence Of Graves’ Disease And Moyamoya Disease:a Case Report And Analysis Of The Clinical Characteristics

Background:Moyamoya disease is a chronic progressive cerebrovascular disorder, with unknown cause, characterized by bilateral stenosis or occlusion of the internal carotid arteries and developing aerosolized capillary network in brain base and leptomeningges. Graves’disease is an autoimmune disease, of which has an excess of thyroid hormone in vivo. Recent years, there were only a few reports about Graves’ disease with Moyamoya disease at home and abroad, which considered some relationships maybe existed between the two diseases, but undefinited.Objects:To research pathogenesis of Graves’disease with Moyamoya disease and relationships between them, and to discuss the clinical characteristics and therapies.Methodsr:In this study, a diagnosed case of Graves’disease in a young woman with Moyamoya disease was reported, and according to literatures searched in the database of CNKI、Pubmed、Chinese scientific and technical journals, we discussed the pathogenesis and clinical characteristics.Results:Reports of Graves’disease and Moyamoya disease were only a few, Kushima et al. reported the coexistence at first in1991. The incidence was higher in Asia than Europe and America, according to literatures, we summaried as follows: Young females had remarkable higher incidence than other age and sexual patients, and the disease had genetic predisposition. Moyamoya disease often attacked during with thyrotoxicosis, currently there were four factors considered as the probable pathogenesis, they were autoimmune reaction、hemodynamics、genetic factor and atherosclerosis, but still undefinited as limited information. Cerebral infaction has remarkable more presentations than hemorrhage in cerebral imaging detection, bilateral was more than unilateral in angiography, and most presented aerosolized capillary network. The severity of moyamoya disease was associated with thyroid function, and moyamoya disease often attacked when the patient was suffering from hyperthyroidism. The stroke was improved along with improvement of thyroid function. Hyperthyroidism therapy could reduce cerebral metabolism, and improved symptoms when united with nervous system therapies. Vascular reconstruction maybe a effective method to prevent strokes.Conclusions:There was some certain relationships in pathogenesis of Graves’ disease and Moyamoya disease, and the former can directly influence Moyamoya disease condition. Sudden change of thyroid hormone level in vivo can induce stroke. Controlling hyperthyroidism can improve moyamoya’s symptoms. For young patients with occlusion of basilar arteries, whether symptoms of hyperthyroidism exist or not, it’s necessary to detect the thyroid function, and do MRA or DSA for helping early diagnosis.