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[Fibromuscular dysplasia. Asymptomatic dissection and occlusion of the basilar artery]

L Benavente1, S Calleja, J M Fernández

  • 1Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo. lbf_benfer@hotmail.com

Neurologia (Barcelona, Spain)
|July 4, 2008
PubMed

Insights

Fibromuscular dysplasia (FMD) of the basilar artery can lead to dissection and occlusion. However, good collateral circulation may ensure a favorable prognosis, even with basilar artery occlusion.

Area of Science:

  • Vascular Neurology
  • Neuroimaging
  • Cerebrovascular Diseases

Background:

  • Basilar artery occlusive disease historically carried a poor prognosis, but recent studies indicate a better outlook.
  • Atherosclerosis is the most common cause of basilar artery disease, though other conditions like fibromuscular dysplasia (FMD) can also affect it.

Observation:

  • A case report details a 46-year-old male with transient ataxic gait and dysarthria.
  • Transcranial Doppler revealed basilar artery stenosis with embolic signals; MR angiography confirmed isolated FMD causing >50% stenosis.
  • Over ten months, the FMD progressed to dissection and complete basilar artery occlusion, with distal filling via posterior communicating arteries.

Findings:

  • Fibromuscular dysplasia of the basilar artery is rare, often asymptomatic, but can progress to dissection or stenosis-related ischemic stroke.
  • Complete basilar artery occlusion, as seen in this case, does not invariably lead to a poor prognosis.
  • Effective collateral circulation, via posterior communicating arteries, played a crucial role in maintaining distal perfusion.

Implications:

  • This case highlights that basilar artery occlusion may have a better prognosis than previously thought, contingent on collateral supply.
  • It underscores the potential for FMD to cause significant basilar artery pathology, including dissection and occlusion.
  • Management strategies for FMD involving the basilar artery warrant careful consideration of collateral status.
Abstract

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