Ni Jun, Gao Shan, Cui Li-ying, Li Shun-wei
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730.
Chin Med Sci J. 2006 Sep;21(3):140-4.
To investigate the distribution and clinical manifestations of intracranial arterial occlusive lesions (IAOLs), and their correlation with thyroid function.
We enrolled 7 patients who had Graves' disease (GD) with IAOLs screened and evidenced by transcranial Doppler, then further confirmed with digital substract angiography in 2 patients and magnetic resonance angiography in 5 patients. Brain magnetic resonance imaging (MRI) was performed in all 7 patients. Three patients were followed up.
Among 7 patients, 1 was male and 6 were females. The mean age was 32.0 +/- 5.5 (range from 11 to 49) years old. Six of them had symptoms of GD but one was asymptomatic with abnormality of T3, T4, and thyroid stimulating hormone. The lesions of intracranial arteries were symmetrical bilaterally in the internal carotid artery system in 6 patients, as well as asymmetrical in 1 patient Terminal internal carotid artery (TICA) were involved in all 7 patients. Middle cerebral artery (MCA) were involved in 3, anterior cerebral artery in 2, and basilar artery in 1 patient. Net-like collateral vessels and mimic moyamoya disease were observed in the vicinity of the occlusive arteries in 2 patients. All patients presented symptoms of ischemic stroke including transient ischemic attack and/or infarction while IAOLs were found. Three patients had obvious involuntary movements. Brain MRI revealed infarctions located in the cortex, basal ganglion, or hemiovular center in 5 patients. The remaining 2 patients had normal brain MRI. The neurological symptoms were improved concomitant with relief of the thyroid function in 2 patients, while IAOLs were aggravated with deterioration of the thyroid function in 1 patient.
IAOLs in patients with GD mainly involve intracranial arteries, especially the TICA and MCA, which is similar to moyamoya disease. The neurological symptoms and severity of involved arteries may relieve while the hyperthyroidism is gradually under control.
探讨颅内动脉闭塞性病变（IAOLs）的分布、临床表现及其与甲状腺功能的相关性。
我们纳入了7例经经颅多普勒筛查并证实患有Graves病（GD）伴IAOLs的患者，其中2例进一步经数字减影血管造影证实，5例经磁共振血管造影证实。对所有7例患者均进行了脑磁共振成像（MRI）检查。对3例患者进行了随访。
7例患者中，男性1例，女性6例。平均年龄为32.0±5.5（11至49岁）岁。其中6例有GD症状，但1例T3、T4和促甲状腺激素异常但无症状。6例患者颅内动脉病变在内颈动脉系统双侧对称，1例不对称。所有7例患者均累及颈内动脉终末段（TICA）。3例累及大脑中动脉（MCA），2例累及大脑前动脉，1例累及基底动脉。2例患者在闭塞动脉附近观察到网状侧支血管和类烟雾病表现。所有患者在发现IAOLs时均出现缺血性卒中症状，包括短暂性脑缺血发作和/或梗死。3例患者有明显的不自主运动。脑MRI显示5例患者梗死位于皮质、基底节或半卵圆中心。其余2例患者脑MRI正常。2例患者的神经症状随着甲状腺功能的缓解而改善，而1例患者的IAOLs随着甲状腺功能的恶化而加重。
GD患者的IAOLs主要累及颅内动脉，尤其是TICA和MCA，与烟雾病相似。随着甲亢逐渐得到控制，神经症状及受累动脉的严重程度可能会缓解。
