Journal List > J Korean Endocr Soc > v.23(1) > 1003475

Choi, Lee, Lee, Kang, Ryu, Kim, Lee, Hong, Kim, Kim, Yoo, Ihm, Choi, and Yoo: A Case of Unilateral Exophthalmos Caused by a Dural Arteriovenous Malformation in Thyroid-Associated Ophthalmopathy

Abstract

Thyroid-associated ophthalmopathy is associated with thyroid dysfunction, particularly Graves' disease, and is manifested as eye signs, including proptosis. In cases of unilateral exophthalmos with thyroid-associated ophthalmopathy, other causes such as orbital neoplasm, carotid-cavernous fistula, cavernous sinus thrombosis, and dural arteriovenous malformation (AVM) should be excluded. Dural AVM, an abnormal dural arteriovenous connection, is a rare neurovascular entity that mimics thyroid-associated ophthalmopathy. When eye involvement is unilateral or asymmetric, dural AVM can be considered in the differential diagnosis of thyroid-associated ophthalmopathy. A twenty-six year-old woman presented with unilateral exophthalmos in Graves' disease. By orbital magnetic resonance imaging and cerebral angiography, thyroid-associated ophthalmopathy and dural AVM were diagnosed. The unilateral exophthalmos improved after coil embolization of the dural AVM. In summary, we report the first case of a dural AVM with Graves' disease and thyroid-associated ophthalmopathy.

Figures and Tables

Fig. 1
Orbital MRI. Right exophthalmos, both extraocular muscle thickening and right retro-orbital vessel engorgement (arrow) are seen.
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Fig. 2
Cerebral angiography reveals dural arteriovenous malformation (AVM) without cortical venous reflex, so called type I AVM (arrows).
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Fig. 3
After selection of dural AVM, coil embolization was performed in abnormal vessel.
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References

1. Bartalena L, Pinchera A, Marcocci C. Management of Graves' ophthalmopathy: reality and perspectives. Endocr Rev. 2000. 21:168–199.
2. Prabhakar BS, Bahn RS, Smith TJ. Current perspective on the pathogenesis of Graves' disease and ophthalmopathy. Endocr Rev. 2003. 24:802–835.
3. Burch HB, Wartofsky L. Graves' ophthalmopathy: current concepts regarding pathogenesis and management. Endocr Rev. 1993. 14:747–793.
4. Drescher EP, Benedict WL. Asymmetric exophthalmos. Arch Ophthal. 1950. 44:109–128.
5. DeSanto LW. The total rehabilitation of Graves' ophthalmopathy. Laryngoscope. 1980. 90:1652–1678.
6. Loré F, Polito E, Cerase A, Bracco S, Loffredo A, Pichierri P, Talidis F. Carotid cavernous fistula in a patient with Graves' ophthalmopathy. J Clin Endocrinol Metab. 2003. 88:3487–3490.
7. Werner SC. Classification of the eye changes Graves' disease. J Clin Endocrinol Metab. 1969. 29:982–984.
8. Mourits MP, Koornneef L, Wiersinga WM, Prummel MF, Berghout A, van der Gaag R. Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach. Br J Ophthalmol. 1989. 73:639–644.
9. The European Group on Graves' Orbitopathy. Clinical assessment of patients with Graves' orbitopathy: the European Group on Graves' Orbitopathy recommendations to generalists, specialists and clinical researchers. Eur J Endocrinol. 2006. 155:387–389.
10. Enzmann DR, Donaldson SS, Kriss JP. Appearance of Graves' disease on orbital computed tomography. J Comput Assist Tomogr. 1979. 3:815–819.
11. Wiersinga WM, Smit T, van der Gaag R, Mourits M, Koornneef L. Clinical presentation of Graves' ophthalmopathy. Ophthalmic Res. 1989. 21:73–82.
12. Forbes G, Gorman CA, Brennan MD, Gehring DG, Ilstrup DM, Earnest F 4th. Ophthalmopathy of Graves' disease: computerized volume measurements of the orbital fat and muscle. AJNR Am J Neuroradiol. 1986. 7:651–656.
13. Fledelius HC, Glydensted C. Ultrasonography and computed tomography in orbital diagnosis: with special reference to dysthyroid ophthalmopathy. Acta Ophthalmol(Copenh). 1978. 56:751–762.
14. Dallow RL. Evaluation of unilateral exophthalmos with ultrasonography: analysis of 258 consecutive cases. Laryngoscope. 1975. 85:1905–1919.
15. Kahaly GJ. Imaging in thyroid-associated orbitopathy. Eur J Endocrinol. 2001. 145:107–118.
16. Kerber CW, Newton TH. The macro and microvasculature of the dura mater. Neuroradiology. 1973. 6:175–179.
17. Awad IA, Little JR, Akarawi WP, Ahl J. Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg. 1990. 72:839–850.
18. Lawton MT, Jacobowitz R, Spetzler RF. Redefined role of angiogenesis in the pathogenesis of dural arteriovenous malformations. J Neurosurg. 1997. 87:267–274.
19. Kiyosue H, Hori Y, Okahara M, Tanoue S, Sagara Y, Matsumoto S, Nagatomi H, Mori H. Treatment of intracranial dural arteriovenous fistulas: current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization. Radiographics. 2004. 24:1637–1653.
20. Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg. 1995. 82:166–179.
21. Houser OW, Baker HL Jr, Rhoton AL Jr, Okazaki H. Intracranial dural arteriovenous malformations. Radiology. 1972. 105:55–64.
22. Djindjian R, Merland J. Meningeal arteriovenous fistula. Superselective arteriography of the external carotid artery. 1978. New York: Springer-Verlag;405–406.
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