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[Fibromuscular dysplasia as a cause of cerebral infarct]
J Sandmann1, C Hojer, H Bewermeyer
1Klinik und Poliklinik für Neurologie, Universität zu Köln.
Abstract:
Fibromuscular dysplasia (FMD) is a non-atheromatous, non-inflammatory, segmental arteriopathy of unknown etiology. Fibroplasia of the tunica media is most common. After the renal arteries, the carotid arteries are most frequently affected. Angiographically beaded and tubular stenoses are seen. Complete occlusions and spontaneous dissection of the carotid arteries occur. The angiopathy causes general symptoms such as headache and vertigo, but also recurrent TIA and ischemic cerebral infarction. We examined 15 patients (12 female) suffering from FMD and stroke. The diagnosis of FMD was based on angiographic findings in all cases. 13 patients made a good recovery and seven of them could be discharged from hospital without any neurological deficit. Apart from conservative treatment, primary percutaneous or operative angioplasty may be necessary in some cases in spite of the mostly benign outcome of the disease. Acetylsalicylic acid should be given in all cases.
Insights
Fibromuscular dysplasia (FMD) is a rare arterial disease affecting carotid arteries. Most patients with FMD and stroke recover well, with some showing no neurological deficits after treatment.
Area of Science:
- Vascular Medicine
- Neurology
Background:
- Fibromuscular dysplasia (FMD) is a non-atheromatous, non-inflammatory arteriopathy affecting medium and large arteries.
- The carotid arteries are frequently involved, leading to symptoms like stroke, TIA, headache, and vertigo.
Observation:
- This study examined 15 patients diagnosed with FMD and stroke, based on angiographic findings.
- The majority of patients (13 out of 15) experienced a good recovery.
- Seven patients were discharged without any neurological deficits.
Findings:
- Carotid artery involvement in FMD can lead to significant neurological events, including transient ischemic attack (TIA) and ischemic cerebral infarction.
- Despite potential for dissection and occlusion, FMD often has a benign outcome with appropriate management.
Implications:
- Early diagnosis and treatment of FMD are crucial for preventing severe neurological complications.
- While conservative management and aspirin are standard, percutaneous or operative angioplasty may be indicated in select cases.
- Further research into the etiology and optimal treatment strategies for FMD is warranted.