Multiple Cerebrovascular Occlusion with Hypothyroidism: A Powerful Compensation

Cerebral vascular occlusion can often cause severe neurological deficits. This study aims to describe a case characterized by multiple large vessel occlusions with hypothyroidism and without clinical symptoms. The patient’s blood vessel condition, compensatory pathway and perfusion situation were understood through medical history inquiry, neurological physical examination, combined with blood lipid, blood glucose, electrocardiogram, transcranial Doppler (TCD), brain computed tomography (CT), cerebral angiography, cerebral perfusion imaging and other examinations. The main symptoms of the patient were dizziness and headache, with no symptoms of neurological function loss. Digital subtraction angiography (DSA) showed multiple large vessel occlusions in the head and neck: the initial part of the left internal carotid artery, the M1 segment of the left middle cerebral artery, the V2 segment of the right vertebral artery, and the V3 terminal segment of the left vertebral artery. According to CT perfusion (CTP) examination, the blood flow (BF) value of the left temporoparietal occipital lobe was lower than that of the contralateral side, the mean blood flow passage time value was increased, and the cerebral blood volume (BV) was slightly higher than that of the contralateral side. Cerebral vascular occlusion is affected by many factors, hypothyroidism can accelerate the process of atherosclerosis, and in severe cases multiple large vessel occlusions may occur. Powerful compensatory mechanisms can reduce the incidence of stroke. J Med Cases. 2019;10(6):158-163 doi: https://doi.org/10.14740/jmc3303