甲状腺功能亢进症相关性烟雾病临床病例分析

Analysis of 6 cases of hyperthyroidism associated moyamoya disease

分析2008年1月—2018年10月开平市中心医院神经内科收治以脑梗死为首发表现的甲状腺功能亢进症相关性烟雾病患者6例的临床资料,其中男1例,女5例,年龄20~40岁,中位年龄29.8岁。既往有甲状腺功能亢进症病史2例,住院期间确诊甲状腺功能亢进症4例。临床表现为肢体乏力4例,失语1例,口角歪斜伴言语含糊1例;头部MR均提示急性脑梗死;头部血管检查示双侧颈内动脉系统末端狭窄、大脑中动脉近端狭窄5例,大脑前动脉近端狭窄2例,3例可见形成异常烟雾状血管团。6例患者均予抗血小板、降脂、规范严格的抗甲状腺功能亢进症药物等治疗,其中3例患者在外院行颅内外血管搭桥重建术。随访6个月,6例患者神经功能明显改善。随访2年,3例药物及手术治疗的患者未见再发脑卒中,仅药物治疗的3例患者中有2例复发脑卒中。提示在临床工作中对于中青年尤其是女性不明原因的缺血性脑卒中患者,在常规进行MRA等无创血管筛查的同时亦应常规行甲状腺功能筛查,可做到早发现,早诊断,早治疗。

Analyzed the clinical data of 6 patients with hyperthyroidism associated moyamoya disease treated in the Department of Neurology of Kaiping Central Hospital from January 2008 to October 2018.There were 1 male and 5 female,aged 20-40 years,with a median of 29.8 years.Two patients had a history of hyperthyroidism,and 4 patients were diagnosed with hyperthyroidism during hospitalization.The clinical manifestations were limb weakness in 4 cases,aphasia in 1 case,angular deviation with speech ambiguity in 1 case;head MR showed acute cerebral infarction;head vascular examination showed 5 cases of bilateral internal carotid artery system stenosis,5 cases of proximal middle cerebral artery stenosis,2 cases of proximal anterior cerebral artery stenosis,3 cases of abnormal smog like vascular mass.All 6 patients were treated with antiplatelet,lipid-lowering and standard anti hyperthyroidism drugs.Among them,3 patients underwent extracranial and extracranial vascular bypass reconstruction.During the follow-up of 6 months,the neurological function of 6 patients improved significantly.During the follow-up of 2 years,there was no recurrence of stroke in 3 patients treated with drugs and surgery,and 2 of the 3 patients with drug treatment only had recurrent stroke.It is suggested that in clinical work,for young and middle-aged patients with ischemic stroke of unknown origin,routine non-invasive vascular screening such as MRA and thyroid function screening should be carried out at the same time,so as to achieve early detection,early diagnosis and early treatment.