Multiple Intracranial Arterial Stenoses around the Circle of Willis in Association with Graves' Disease: Report of Two Cases

Abstract

Abstract OBJECTIVE AND IMPORTANCE The association of Graves' disease with multiple intracranial arterial stenoses is rare. CLINICAL PRESENTATION We report on two Japanese women who experienced the concurrence of Graves' disease and cerebral ischemia attributable to multiple intracranial arterial stenoses around the circle of Willis. Clinically, these patients demonstrated hyperthyroidism, goiter, ophthalmopathy, and ensuing ischemic strokes. Cerebral angiography demonstrated multiple intracranial arterial stenoses around the circle of Willis in both cases. These cases did not meet the full diagnostic criteria for moyamoya disease, in that there were no abnormal, net-like, collateral vessels, but the other clinical and angiographic findings were consistent with this condition. INTERVENTION After normalization of their hormonal conditions, the patients underwent cerebral revascularization procedures. Both patients achieved excellent recoveries and returned to normal daily life after treatment. CONCLUSION Multiple intracranial arterial stenoses and Graves' disease may occur simultaneously. Such cases may offer new insights into the pathogenesis of these two conditions. It is important to study more patients with this dual condition, to obtain more evidence of the relationship between genetic and immunogenic backgrounds.