Severe Cerebral Vasospasm in Patients with Hyperthyroidism.

Area of Science:

• Neurology
• Endocrinology
• Vascular Medicine

Background:

• Cerebral vasospasm is a known complication of hyperthyroidism, but its association with cerebral infarction has not been previously documented.
• Hyperthyroidism can affect cerebral vascular hemodynamics, potentially increasing the risk of cerebrovascular events.

Observation:

• A 30-year-old woman with a history of hyperthyroidism presented with stupor and right hemiparesis.
• Initial assessment revealed no neurological deficits or radiological abnormalities, but subsequent MRI and angiography demonstrated cerebral infarction with severe vasospasm.
• The patient had recently discontinued her antithyroid medication.

Findings:

• The patient underwent chemical angioplasty with verapamil and received antithyroid medication.
• Follow-up angiography at 6 weeks showed complete resolution of vasospasm.
• At 2-year follow-up, the patient exhibited mild weakness and cortical blindness.

Implications:

• This case underscores the potential link between severe vasospasm, cerebral infarction, and hyperthyroidism.
• Sudden increases in thyroid hormone levels should be avoided to prevent cerebrovascular accidents.
• Neurological deterioration without clear parenchymal lesions warrants thyroid function evaluation.