[Unusual neurologic manifestation of Graves-Basedow disease]

A 74 year old, male patient had an acute, painful bilateral exophtalmos, ptosis, ophtalmopathy and vision impairment. The CT-scan showed a thickness of the extrinsic ocular muscles which oriented the diagnosis of Graves-Basedow disease, later confirmed by the laboratory test. We highlight the rarity of the acute onset contrary to the slowly progressive ophtalmopathy frequently seen in this type of thyrotoxicosis, as well as the importance of the orbital CT-scan for an early diagnosis. We review the pathogenic theories of the process with its important immunologic back-ground, taking part the humoral and the cellular immunity associated with the HLA-B35 haplotype commenting on the good response to high dosage of steroids, later combined with bromocriptine.