ReviewMedicine2026
Graves' disease-related reversible intracranial arteriopathy presenting with ischemic stroke: A case report and literature review.
Review in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
rationaleGraves' disease (GD) may be associated with ischemic stroke through nonatherosclerotic intracranial arteriopathy during thyrotoxicosis. However, the optimal antithrombotic regimen and treatment duration for this condition remain uncertain. PATIENT CONCERNS: A 38-year-old man presented approximately 6.5 hours after the last known well with sudden dysarthria, aphasia, and right-sided weakness. His National Institutes of Health Stroke Scale (NIHSS) score was 9 on admission. DIAGNOSES: Brain magnetic resonance imaging demonstrated acute ischemic infarcts, and magnetic resonance angiography revealed left middle cerebral artery M2 stenosis. In the setting of overt Graves' thyrotoxicosis and no identified alternative stroke source, the findings supported a diagnosis of Graves' disease-related reversible intracranial arteriopathy presenting with ischemic stroke.
interventionsThe patient received dual antiplatelet therapy with aspirin 100 mg and clopidogrel 75 mg daily for 21 days, together with atorvastatin and antithyroid treatment with thiamazole. The thiamazole dosage was subsequently adjusted according to serial thyroid function tests. OUTCOMES: The patient's neurological deficits improved rapidly, and his NIHSS score decreased to 1 at discharge. Biochemical euthyroidism was achieved approximately 5 months after treatment initiation. At 12 months, magnetic resonance angiography demonstrated marked reversal of the left M2 stenosis. At the latest follow-up at 24 months, the patient was neurologically intact and remained free of recurrent ischemic or hemorrhagic events. LESSONS: Graves' disease-related reversible intracranial arteriopathy should be considered in young patients presenting with ischemic stroke, intracranial arterial stenosis, and thyrotoxicosis. This case suggests that short-term dual antiplatelet therapy may be considered as early bridging treatment in selected patients, whereas long-term management should prioritize sustained thyroid control and clinical and vascular imaging follow-up. Further evidence is required to establish the optimal antithrombotic regimen, treatment duration, and criteria for discontinuation.
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