Cerebral Infarction and Recovery in a 12-Year-Old Child With Intracranial Fibromuscular Dysplasia
Min Hwan Kim1, Jae In Lee1, Shin-Seung Yang1
1Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
Insights
Fibromuscular dysplasia (FMD), a rare condition causing arterial narrowing, can lead to pediatric stroke. This case highlights FMD in the middle cerebral artery (MCA) in a young patient, emphasizing its potential as a stroke cause.
Area of Science:
- Neurology
- Vascular Medicine
- Pediatrics
Background:
- Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic arterial disease causing stenosis, typically affecting renal and carotid arteries.
- Intracranial FMD is rare in pediatric populations, making its association with stroke in this age group uncommon.
Observation:
- A 14-year-old boy presented with acute ischemic stroke symptoms, including left-side weakness.
- Brain imaging confirmed a stroke in the right basal ganglia and internal capsule.
- MR angiography and transfemoral angiography revealed segmental stenosis and the characteristic "string of beads" sign in the left middle cerebral artery (MCA).
Findings:
- The patient was diagnosed with fibromuscular dysplasia affecting the middle cerebral artery.
- The ischemic stroke occurred in the context of intracranial FMD in a pediatric patient.
- The patient showed gradual recovery from motor deficits following the event.
Implications:
- Fibromuscular dysplasia should be considered in the differential diagnosis of ischemic stroke in children.
- This case underscores the importance of investigating rare vascular causes for pediatric stroke.
- Early recognition and management of FMD can potentially improve outcomes in young stroke patients.
Abstract:
Fibromuscular dysplasia (FMD) is a congenital vascular anomaly resulting in arterial stenosis and weakening of typically medium-sized arteries. It is a noninflammatory, nonatherosclerotic arterial disease that affects most commonly the renal and internal carotid arteries, but intracranial FMD in the pediatric population is very rare. We report a young age-onset ischemic stroke patient with FMD affecting the middle cerebral artery (MCA). A 14-year-old boy was admitted with left-side weakness during physical education at school. The brain magnetic resonance (MR) imaging revealed an acute ischemic stroke in the right basal ganglia and internal capsule, while the MR angiogram showed segmental intraluminal stenosis in the left proximal MCA. The transfemoral angiography revealed the pathognomonic sign of a "string of beads" at the proximal MCA area. The clinical course was stable, and the boy gradually recovered from the motor weakness of his arm and leg. FMD should be considered as a potential cause of pediatric stroke.
