Ischaemic stroke in hyperthyroidism without cardiac arrhythmia - A case report from South East Nigeria

Abstract

BACKGROUND: The relationship between hyperthyroidism and stroke is well established in the setting of atrial fibrillation. However there is limited literature for ischaemic stroke occurring in hyperthyroidism without cardiac arrhythmia.  No such case had been described in South East Nigeria.
METHOD: This report highlights a case of ischaemic lacunar infarction in an elderly Nigerian woman with re-emergent thyrotoxicosis, without atrial fibrillation.
RESULT: A 75- year old retired female teacher presented with a painless goiter of 3 years duration and right sided hemiplegia of 2 months duration. She had sub-total thyroidectomy 32 years ago for  thyrotoxicosis with subsequent good outcome  and had been managed for diabetes mellitus for 13 years with good glycaemic control. She was not a known hypertensive. She was thyrotoxic on examination with a large non- tender goiter. There was sinus tachycardia. She had a right sided facial nerve palsy and ipsilateral spastic hemiplegia. Sensations were spared. Results of investigations confirmed hyperthyroidism while brain CT scan was unremarkable except for cerebral atrophy. She had no other associated risk factor associated with hyperthyroidism. Within two weeks of admission she was stabilized on anti-thyroid and anti-diabetic medications, her motor functions significantly recovered and she was independent. She was discharged to be followed up at the out-patients' clinic. 
CONCLUSION: Ischaemic stroke may present in hyperthyroid patients without atrial fibrillation. This possibility needs to be entertained despite the absence of cardiac arrhythmia or other well established factors for cardioembolic stroke. There is a need for more studies on this relationship.

KEY WORDS: ischaemic stroke, hyperthyroidism, South East Nigeria.