title: Neurologic improvement without angiographic improvement after antithyroid therapy in a patient with Moyamoya syndrome.
abstract: Moyamoya disease with special complications, including Graves' disease, is called as moyamoya syndrome. A 22-year-old Japanese woman had left middle cerebral artery (MCA) territory infarction complicated with Graves' disease. She had right-sided hemiparesis that deteriorated on day 8 with the infarct growth and thyrotoxicosis. On angiogram, the left MCA was occluded at the origin without moyamoya vessels. Positron emission tomography (PET) revealed misery-perfusion phenomenon in the left MCA territory. After initiation of the antithyroid therapy, her hemiparesis became milder. Seventeen months later, her thyroid function was normalized and net-like collateral moyamoya vessels proliferated in the left MCA territory. Misery-perfusion phenomenon persisted on PET. This report is unique in the point of neurologic recovery of the moyamoya patient right after initiation of antithyroid medication without radiological improvement.
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: ishigami.akiko.hp@ncvc.go.jp.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ishigami
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Rieko
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Miyashita
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D013956:Antithyroid Agents / Q000627:therapeutic use*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006111:Graves Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D009072:Moyamoya Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D018919:Neovascularization, Physiologic; D055420:Perfusion Imaging / Q000379:methods; D049268:Positron-Emission Tomography; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013956:Antithyroid Agents
keywords: Graves' disease; Moyamoya syndrome; antithyroid therapy