Authors
Lakshmi Priyaa, Kavya BKa, Purushottam Acharyaa, Mahendra Javalia, Pradeep Ra, Anish Mehtaa
a. Department of Neurology, MS Ramaiah Medical College, Bangalore
Abstract
Background: Arterial dissection is one of the common etiologies of young ischemic strokes. We report a case of Graves’ disease presenting as isolated spontaneous cervical internal carotid artery dissection followed by subarachnoid haemorrhage.
Case Presentation: A young female in her early 40s presented with 3-day history of headache and left hemiparesis. MRI of the Brain showed acute right hemispheric watershed infarcts. CT Angiogram showed a short segment right cervical internal carotid artery dissection. Her serum TSH was markedly reduced with an elevated free T3/free T4 ratio (1.78) and strongly positive Anti TSH-R antibodies.
Treatment and Outcome: She was treated with anticoagulants and antithyroid medications. Still, later she developed an episode of focal seizure following right frontal subarachnoid hemorrhage, when anticoagulation was stopped and started on a single antiplatelet, with which she recovered well.
Conclusion: Spontaneous cervical internal carotid artery dissection and focal subarachnoid haemorrhage presenting secondary to Graves’ disease without any other symptomatic systemic manifestations of hyperthyroidism is probably rare.