Graves病合并烟雾病的MRI表现和临床特征

MRI Findings and Clinical Features of Graves' Disease Complicated with Moyamoya Disease

目的分析Graves病合并烟雾病的MRI表现和临床特征,探讨两种疾病之间可能存在的病因学联系。资料与方法回顾性分析7例Graves病合并烟雾病患者的临床表现,7例均行头部MRI和MRA检查以及甲状腺功能检测。其中男1例,女6例,年龄14～58岁,平均28.4岁。7例患者的甲状腺功能检查均异常。4例既往有甲状腺功能亢进病史,3例住院期间查出甲亢。临床表现:肢体偏瘫和运动性失语3例,肢体抽搐3例,右上肢和右侧颜面部麻木1例。结果MRI表现:急性脑梗死5例,陈旧性脑梗死伴缺血灶1例,无异常1例。MRA表现:双侧颈内动脉系统狭窄或闭塞6例,1例单侧颈内动脉系统受累。其中,大脑中动脉近端狭窄7例,颈内动脉末端狭窄5例,大脑前动脉近端狭窄2例。仅2例见网状侧支血管。结论Graves病可能是烟雾病的一个病因,对于MRA显示烟雾病的中青年女性,无论是否有甲状腺功能亢进症状,均有必要进行甲状腺功能检测。

Objective To analyze the MRI findings and clinical features of Graves＇disease complicated with moyamoya disease, and to explore the possible etiological correlation between Graves＇disease and moyamoya disease. Materials and Methods The clinical manifestations in 7 cases （ 1 male and 6 females, with the mean age of 28.4 years, range from 14 to 58 years） with Graves＇disease complicated with rnoyamoya disease were retrospectively analyzed, Brain MRI, MRA and thyroid function tests were performed in these 7 cases. Thyroid function tests were abnormal in all 7 patients. 4 patientss had the history of hyperthyroidism and 3 were diagnosed with hyperthyroidism in the duration of hospital stay. The clinical symptoms, included hemiplegia in the limbs with anandia in 3 patients, convulsion in the limbs in 3 patients, and numbness in the right upper limb and right face in 1 patient. Results MRI showed acute cerebral infarction in 5 patients, obsolete cerebral infarction with ischemia lesions in 1 patient, and normal in another one. MRA showed bilateral internal carotid ar- tery system was stenosis or occlusive in 6 patients, as well as unilateral in 1 patient. Middle cerebral artery were involved in all7 patients, internal carotid artery were involved in 5, anterior cerebral artery in 2. Net-like collateral vessels were ob- served in the vicinity of Willis circle in 2 patients. Conclusion Gravesitisease is a possible etiological factor of moyamoya disease. It is necessary to perform thyroid function tests for the young or middle-aged female with moyamoya disease showed by MRA ,with or without the symptoms of hyperthyroidism.