Yamashita Shiro, Tamiya Takashi, Shindo Atsushi, Miyake Keisuke, Nakamura Takehiro, Ogawa Daisuke, Kuroda Yasuhiro, Nagao Seigo
Department of Neurological Surgery, Kagawa University School of Medicine.
Neurol Med Chir (Tokyo). 2005 Nov;45(11):578-82. doi: 10.2176/nmc.45.578.
A 29-year-old female presented with Basedow's disease manifesting as sudden vomiting, diarrhea, fever over 38 degrees C, transient aphasia, and numbness in her extremities. These symptoms were considered due to cerebral ischemia at a local clinic. Magnetic resonance angiography indicated stenosis of the bilateral distal internal carotid arteries and the bilateral proximal anterior cerebral and middle cerebral arteries. Thyroid swelling and exophthalmos were observed. She was transferred to our hospital. Endocrine function tests showed hyperthyroidism. The diagnosis was Basedow's disease. Her symptoms disappeared after receiving intravenous drip infusion of fluid replacement, and antithyroid and antiplatelet medication. After she became euthyroid, cerebral angiography and magnetic resonance angiography revealed improvement of the stenosis of the cerebral arteries. Stenosis of the terminal portion of the internal carotid artery associated with Basedow's disease is extremely rare. Conservative treatment mainly including antithyroid medications for Basedow's disease, and antiplatelet drugs and intravenous replacement fluid for the ischemic manifestations should be the first choice of treatment unless immediate vascular reconstruction is necessary.
一名29岁女性因突眼性甲状腺肿就诊，表现为突发呕吐、腹泻、体温超过38摄氏度、短暂性失语及肢体麻木。在当地诊所，这些症状被认为是由脑缺血引起的。磁共振血管造影显示双侧颈内动脉远端及双侧大脑前动脉和大脑中动脉近端狭窄。观察到甲状腺肿大和眼球突出。她被转至我院。内分泌功能检查显示甲状腺功能亢进。诊断为突眼性甲状腺肿。在接受静脉补液、抗甲状腺及抗血小板药物治疗后，她的症状消失。甲状腺功能恢复正常后，脑血管造影和磁共振血管造影显示脑动脉狭窄有所改善。与突眼性甲状腺肿相关的颈内动脉末端狭窄极为罕见。除非有必要立即进行血管重建，否则以抗甲状腺药物治疗突眼性甲状腺肿、抗血小板药物及静脉补液治疗缺血表现为主的保守治疗应作为首选治疗方法。
