Spontaneous Unilateral Carotid Dissection: A Case Report of a Rare Complication in a Patient With Graves' Disease.

Autor:	Contreras-Saldarriaga JE; Department of Endocrinology, University of Antioquia, Medellín, COL., López-Arbelaez AM; Department of Internal Medicine, University of Antioquia, Medellín, COL., Solano-Villamarin A; Department of Vascular Medicine, University of Antioquia, Medellin, COL., Arroyo-Ripoll OF; Department of Endocrinology, University of Antioquia, Medellín, COL., Román-González A; Department of Endocrinology and Metabolism, University of Antioquia, Hospital San Vicente Foundation, Medellín, COL.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Oct 24; Vol. 16 (10), pp. e72298. Date of Electronic Publication: 2024 Oct 24 (Print Publication: 2024).
DOI:	10.7759/cureus.72298
Abstrakt:	Carotid artery dissection (CAD) is a recognized cause of ischemic stroke (IS) in young adults. At the same time, hyperthyroidism, particularly in the context of thyroid storm (TS), can also lead to IS through mechanisms related and unrelated to atrial fibrillation (AF). However, the coexistence of CAD and thyrotoxicosis is extremely rare. We report the case of a 45-year-old woman with Graves' disease (GD) who presented with TS, developing IS secondary to left CAD. The patient had a history of poorly controlled hyperthyroidism despite being on methimazole and beta-blocker therapy. Upon admission, she presented with fever, diarrhea, tremor, and palpitations. Physical examination revealed bilateral exophthalmos, goiter, and AF. Thyroid function tests confirmed TS, and treatment was initiated with antithyroid drugs, beta-blockers, glucocorticoids, and plasma exchange. Three days later, she developed focal neurological symptoms, and imaging studies revealed multiple ischemic lesions in the left middle cerebral artery territory. Further investigation confirmed left internal CAD, with no evidence of trauma or other underlying conditions to explain the dissection, leading to the conclusion that GD was the likely cause. The patient underwent thyroidectomy with subsequent clinical improvement, and she was discharged in good condition with long-term anticoagulation due to the presence of AF. This case highlights a rare association between GD and CAD, emphasizing the importance of considering CAD in patients with thyrotoxicosis who present with unexplained focal neurological symptoms. Early recognition and management of TS and CAD can improve clinical outcomes. Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Contreras-Saldarriaga et al.)
Databáze:	MEDLINE
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