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Spontaneous internal carotid artery dissection (ICAD) is a major cause of stroke in young adults.1 Environmental factors, such as minor trauma and mechanical stretching, may trigger the dissection, especially in patients with an underlying arteriopathy. Despite the direct vascular effects of thyroid hormones (THs),2–4⇓⇓ the predisposition for arterial dissection has not been identified in Graves disease (GD). We describe two women with bilateral ICAD and GD with fatal outcome, one with histopathologic study.
Case reports.
Patient 1.
A 45-year-old woman with irregular treatment for GD was admitted after 6 hours of right hemiparesis and aphasia. She had no vascular risk factors. On admission, her blood pressure was 130/80 mm Hg, and her pulse was 150 beats/min. She presented a mild nonfluent aphasia and right-sided hemiparesis. EKG showed sinusal tachycardia. Brain CT showed an ischemic infarct in left middle cerebral artery (MCA) territory. Angiography detected bilateral irregular high-grade stenosis starting 2 cm distal to …
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