A case of acute ischemic stroke in moyamoya syndrome associated with Graves’ disease: Is there a role for anti-dsDNA antibodies?

Abstract

The coexistence of Moyamoya syndrome (MMS) and Graves’ disease (GD) is uncommon. Here, we report a case of a 41-year-old Filipino female, who presented with thyrotoxicosis and acute ischemic stroke. Based on her clinical presentation, cerebral computed tomography angiography, and thyroid function tests, she was diagnosed with MMS and GD. Her Burch-Wartofsky point scale score was 30, suggesting an impending thyroid storm. Antithyroid therapy was started with her neurological status deterioration initially, but after controlling the thyroid storm, the patient’s neurological status stabilized. She remained stable till she travelled to her country. We hypothesized that MMS in a patient with GD is mediated through anti-dsDNA antibodies, by altering key biological mechanisms, that is, inflammation, neutrophil extracellular traps, and apoptosis that drive a distinctive and coordinated immune and vascular activation. To the best of our knowledge, this is the first case of MMS associated with GD reported in Qatar.