Fibromuscular dysplasia as a rare cause of ischaemic stroke - a case report

Fibromuscular dysplasia (FMD) is a rare cause of ischemic stroke. It is an important element of differential diagnosis that should be considered, especially in patients who do not have common cardiovascular risk factors. A 65-year-old man was admitted with transient left arm weakness and drooping of the mouth, asting about 3 minutes, followed by left-sided paresthesia. A similar episode had occurred a week earlier. On admission, the patient was alert and oriented. Neurological exam showed subtle flattening of the left nasolabial fold and a tendency to a positive ipsilateral Babinski sign, with no other abnormalities. Brain MRI revealed a subacute ischemic lesion in the anterior deep structures and a hyperacute focus at the right temporo-occipital border. CT angiography showed bilateral internal carotid artery changes suggestive of FMD, critical stenosis of the right MCA (M1), and aneurysmal dilation of the left ophthalmic artery origin. Digital subtraction angiography (DSA) confirmed a wide-neck saccular aneurysm of the left internal carotid artery (ICA). Rehabilitation and multidisciplinary consultations were undertaken. The patient was discharged in good condition without significant neurological deficits. Regular blood pressure control, atherosclerotic diet, physical activation and taking medications (antihypertensive drugs, acetylsalicylic acid and statin) regularly were recommended. Due to the diagnosis of a saccular aneurysm of the left ICA, a referral was issued to the neurosurgery department. The described case illustrates the need for a comprehensive and interdisciplinary approach to a patient with stroke in order to determine the etiology of the stroke and implement secondary prevention.