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Border-Zone Infarction Due to Cerebrovascular Fibromuscular Dysplasia
Yu-Ming Chen1,2
1Department of Neurology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan.
Abstract:
A 45-year-old male presented with acute-onset left-sided weakness and slurred speech. Non-contrast-enhanced brain magnetic resonance imaging revealed cortical and internal border-zone infarcts compatible with stroke. A survey of ischemic stroke risk factors in young adults excluded coagulopathy, vasculitis, and cardiac disease. Nevertheless, neck-computed tomography angiography revealed a long-segmental narrowing of the right internal carotid artery with wall thickening and a "string-of-beads" appearance suspicious for fibromuscular dysplasia, which was confirmed on further angiography. His clinical condition stabilized after intensive medical therapy. This case demonstrates cerebrovascular fibromuscular dysplasia as a possible cause of ischemic stroke in young adults.
Insights
Fibromuscular dysplasia is a rare vascular condition that can cause ischemic stroke in young adults. This case highlights its importance in stroke diagnosis.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Ischemic stroke in young adults is uncommon, necessitating investigation into diverse etiologies.
- Cerebrovascular fibromuscular dysplasia (FMD) is a rare, non-atherosclerotic vascular disease that can affect arteries supplying the brain.
- Identifying FMD is crucial for appropriate management and secondary stroke prevention.
Purpose of the Study:
- To present a case of ischemic stroke in a young adult attributed to cerebrovascular fibromuscular dysplasia.
- To emphasize the diagnostic utility of advanced imaging in identifying FMD.
- To raise awareness of FMD as a potential cause of stroke in younger populations.
Main Methods:
- A 45-year-old male presented with acute stroke symptoms.
- Brain MRI revealed infarcts, prompting a workup for stroke risk factors.
- Computed tomography angiography (CTA) and conventional angiography were used to visualize the internal carotid artery.
Main Results:
- Initial investigations excluded common stroke etiologies like coagulopathy, vasculitis, and cardiac disease.
- Neck CTA demonstrated characteristic "string-of-beads" appearance in the right internal carotid artery, indicative of FMD.
- Cerebrovascular fibromuscular dysplasia was confirmed, and the patient's condition stabilized with medical therapy.
Conclusions:
- Cerebrovascular fibromuscular dysplasia should be considered in the differential diagnosis of ischemic stroke in young adults.
- Advanced imaging techniques, including CTA and angiography, are essential for diagnosing FMD.
- Early recognition and management of FMD can lead to improved patient outcomes and stroke prevention.
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