Two adolescent patients with coexistent Graves' disease and Moyamoya disease in Korea

Area of Science:

• Neurology and Endocrinology
• Cerebrovascular Diseases
• Autoimmune Disorders

Background:

• Moyamoya disease involves progressive narrowing of cerebral arteries at the base of the brain.
• Graves' disease is an autoimmune disorder affecting the thyroid gland.
• The co-occurrence of Moyamoya disease and Graves' disease, particularly in adolescents, is rare and poorly understood.

Purpose of the Study:

• To report two adolescent cases of Moyamoya disease associated with Graves' disease.
• To investigate the potential link between these two conditions in a euthyroid state.
• To highlight the importance of recognizing this association for timely diagnosis and treatment.

Main Methods:

• Case study of two adolescent patients presenting with hemiparesis and syncope.
• Diagnostic evaluation included thyroid function tests and neuroimaging (MRA, cerebral angiography).
• Treatment involved cranial revascularization surgery (encephalo-duroarterio-synangiosis).

Main Results:

• Both patients were diagnosed with Moyamoya disease and Graves' disease, presenting as euthyroid with elevated TSH receptor antibodies.
• Cranial revascularization surgery led to successful resolution of neurological symptoms.
• Patients experienced positive outcomes with no further neurological complications at follow-up.

Conclusions:

• This report details the first known cases in South Korea of adolescent Moyamoya disease associated with Graves' disease in a euthyroid state.
• The findings suggest a possible, though obscure, relationship between Moyamoya disease and Graves' disease that warrants further investigation.
• Early surgical intervention for Moyamoya disease can lead to favorable neurological outcomes.