CONCURRENCE OF GRAVES-DISEASE AND DYSPLASTIC CEREBRAL BLOOD-VESSELS OF THE MOYAMOYA VARIETY

We describe two Caucasian women with the concurrence of Craves' diseas e and the moyamoya phenomenon (radiological evidence of collateral cer ebral blood vessels like ''puffs of smoke'' due to cerebrovascular occ lusive disease). One patient presented with acute cerebrovascular isch emia due to Moyamoya disease shortly after radioactive iodine therapy for Graves' disease and the second presented with Graves' disease 10 y ears after being diagnosed with moyamoya dysplastic cerebral vessels. The optimal treatment of hyperthyroidism in these patients is unknown; however, careful control of the hyperthyroidism by any modality seems reasonable. Our limited experience suggests that antithyroid drugs an d radioactive iodine therapy are rational options. Thyroidectomy appea rs to be a safe therapeutic alternative, although long-term efficacy m ay be difficult to assure. Both of our patients had to be treated twic e for hyperthyroidism. Whether Graves' disease and Moyamoya coexist be cause of an aggressive autoimmune mechanism is a concept that remains to be settled.