Spontaneous Arterial Dissection Secondary to Graves' Disease: A Possible Association

Abstract

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. 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. 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. 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.