Progression of right internal carotid artery stenosis in ischemic stroke patient with autoimmune polyglandular syndrome: A case report

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  • Kanazawa Yuka
    Division of Cerebrovascular Medicine, St-Mary’s Hospital
  • Matsuo Ryu
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  • Fukushima Yoshihisa
    Division of Cerebrovascular Medicine, St-Mary’s Hospital
  • Fukuda Kenji
    Division of Cerebrovascular Medicine, St-Mary’s Hospital
  • Kamouchi Masahiro
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  • Kitazono Takanari
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University

Bibliographic Information

Other Title
  • 進行する頸動脈病変をみとめた多腺性自己免疫症候群合併脳梗塞の1例
  • 症例報告 進行する頸動脈病変をみとめた多腺性自己免疫症候群合併脳梗塞の1例
  • ショウレイ ホウコク シンコウ スル ケイドウミャク ビョウヘン オ ミトメタ タセンセイ ジコ メンエキ ショウコウグン ガッペイ ノウ コウソク ノ 1レイ

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A 40-year-old man who presented with left hemiparesis was admitted to our hospital. He had tachycardia and a fever. He had a 25-year history of insulin therapy for diabetes mellitus. Brain magnetic resonance (MR) images showed fresh infarction in the right hemisphere, and carotid ultrasonography showed stenosis of the right internal carotid artery (ICA). We determined that atherothrombotic brain infarction had likely occurred. After admission, the right ICA became narrow and finally occluded. Computed tomography revealed the presence of a thrombus in the right ICA, and gadolinium-enhanced MRA showed vasculitis of the ICA. In laboratory tests, his thyroid hormones were elevated. He was diagnosed with hyperthyroidism. After treatment, the tachycardia and high fever were improved. Because of a positive anti-glutamic acid decarboxylase antibody test result, he was diagnosed with insulin-dependent diabetes mellitus. We found that he had anti-phospholipid antibody syndrome because he was positive for anti-beta-glycoprotein I antibody. These findings suggested that his condition was autoimmune polyglandular syndrome type 3. He received prednisolone and warfarin. After 3 months, his neurological findings were improved; however, occlusion of the ICA remained. Autoimmunity was considered to be the cause of ICA occlusion. Ischemic stroke with autoimmune polyglandular syndrome is very rare and is associated with progressive carotid lesions in juvenile patients. It is necessary to diagnose and treat this condition as soon as possible.

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 53 (7), 531-535, 2013

    Societas Neurologica Japonica

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