Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Florida.
Department of Neurosurgery, Leonard M. Miller School of Medicine, University of Miami, Florida.
World Neurosurg. 2016 Aug;92:95-107. doi: 10.1016/j.wneu.2016.04.122. Epub 2016 May 7.
Moyamoya disease is a cerebral vasculopathy characterized by stenosis of the terminal internal carotid artery, proximal middle cerebral artery, and anterior cerebral artery. There is an association between moyamoya vasculopathy and Graves disease, primarily in Asian populations. Here, we present the largest series of non-Asian, predominantly Latino patients with moyamoya vasculopathy in the setting of Graves thyrotoxicosis, as well as the largest review of the literature to date.
We retrospectively analyzed patients presenting with stroke in the setting of clinical Graves disease to our institution from 2004 to 2014. Moyamoya vasculopathy was diagnosed by magnetic resonance angiography in all patients.
Eight patients with Graves disease thyrotoxicosis and moyamoya vasculopathy were identified. Six patients were effectively managed with aggressive medical management using antithyroid and antiplatelet medications. No recurrent strokes were noted once thyrotoxicosis was controlled. Intracranial bypass was necessary in 2 patients who failed medical management. Seventy-nine additional cases were reported from the literature. There was no significant difference in clinical improvement between medical therapy alone and medical therapy with neurosurgical prophylaxis (87.0% vs. 88.0%, respectively; P = 0.94).
Moyamoya vasculopathy associated with Graves disease thyrotoxicosis in non-Asian women may be more common than previously thought. In addition, our series suggests that thyrotoxicosis promotes the progression of vasculopathy. Based on our review, there is no significant difference in clinical improvement between proper medical and surgical therapies. Aggressive medical therapy should be considered first-line treatment for moyamoya vasculopathy with Graves thyrotoxicosis, with neurosurgical rescue reserved for medically refractory cases.
烟雾病是一种以颈内动脉末端、大脑中动脉近端和大脑前动脉狭窄为特征的脑血管疾病。烟雾病与格雷夫斯病（Graves disease）之间存在关联，主要见于亚洲人群。在这里，我们报告了最大系列的非亚洲、以拉丁裔为主的格雷夫斯病甲状腺毒症患者烟雾病血管病变，以及迄今为止最大的文献综述。
我们回顾性分析了 2004 年至 2014 年期间我院因临床格雷夫斯病并发卒中的患者。所有患者均通过磁共振血管造影诊断为烟雾病血管病变。
确定了 8 例格雷夫斯病甲状腺毒症并发烟雾病血管病变的患者。6 例患者通过使用抗甲状腺和抗血小板药物进行积极的药物治疗得到有效治疗。一旦甲状腺毒症得到控制，就没有再次发生中风的情况。2 例经药物治疗失败的患者需要进行颅内旁路手术。文献中还报告了另外 79 例病例。单纯药物治疗与药物治疗联合神经外科预防的临床改善之间无显著差异（分别为 87.0%和 88.0%；P=0.94）。
非亚洲女性的格雷夫斯病甲状腺毒症相关的烟雾病血管病变可能比以前认为的更为常见。此外，我们的系列研究表明，甲状腺毒症会促进血管病变的进展。基于我们的综述，适当的药物和手术治疗在临床改善方面没有显著差异。对于格雷夫斯病甲状腺毒症并发烟雾病血管病变，应首先考虑积极的药物治疗，对于药物难治性病例保留神经外科治疗。
