[Fibromuscular dysplasia with an internal carotid artery web on the angiograms]

A 58-year-old woman experienced a transient right-sided hemianopsia. She also had difficulty finding words and trouble naming parts of objects. On admission, three days later, there were no signs of residual neurological deficit. Laboratory studies showed findings of neither diabetes mellitus, hypertension nor cardiac disease. Her serum cholesterol level was normal. No bruit was heard over the head and neck. Preoperative angiograms showed a discrete web (septum) at the left internal carotid origin (Fig. 2). 123I-IMP SPECT revealed a decreased areas of perfusion mainly in the left middle cerebral artery distribution (Fig. 3A). A reconstructive operation was performed. A firm discrete nonatherosclerotic ridge (septum) protruding into the vessel lumen was resected. Microscopic examination of the surgical specimen demonstrated intimal fibroplasia, a rare subtype of fibromuscular dysplasia (FMD). Postoperatively, hypoperfused areas in SPECT were improved (Fig. 3B). The patient has been free of symptoms to the present time (for about one year). In addition to the rarity of the lesion, the available data suggest that web-like subtype of FMD is apt to be associated with an increase in the risk of hemodynamic compromise and thromboembolism. Surgical therapy is recommended, especially for symptomatic patients.