Stroke secondary to FMD

Definition:

Damage to brain tissue caused by fibromuscular dysplasia, an inherited disorder that leads to the destruction of arterial blood vessels which can cause bleeding in the brain.

Alternative Names:

Fibromuscular dysplasia - stroke secondary to

Causes, incidence, and risk factors:

Stroke secondary to fibromuscular dysplasia (FMD) primarily affects women, especially those older than 50.

FMD is an inherited disorder involving the ongoing destruction of arterial blood vessels. There are areas of increased muscle and fibrous tissue in the wall of the affected arteries, which alternate with enlarged (dilated) areas where the tissue has been destroyed. This irregularity in the arteries increases the risk for stroke.

The disease may affect the neck arteries that supply blood to the brain (carotid) or the arteries within the brain (cerebral) and cause stroke. It may also affect the following arteries:

kidneys (renal)
intestinal tract (mesenteric)
heart (coronary)
groin (iliac)

Secondary symptoms include high blood pressure, leg pain, heart attack, kidney failure, and other disorders.

Risks include a personal or family history of FMD.

Symptoms:

Weakness or total inability to move a body part
Numbness, loss of sensation
Tingling or other abnormal sensations
Decreased or lost vision, partial or temporary
Language difficulties (aphasia)
Inability to recognize or identify sensory stimuli (agnosia)
Loss of memory
Vertigo (abnormal sensation of movement)
Loss of coordination
Swallowing difficulties
Personality changes
Mood and emotion changes
Urinary incontinence (lack of control over bladder)
Lack of control over the bowels
Consciousness changes:
- Sleepy
- Stuporous, somnolent, lethargic
- Comatose, unconscious

Signs and tests:

The exact location and extent of the stroke, and changes in the arteries indicating FMD including berry aneurysms (small ballooned-out areas of the artery), may be seen on:

Head CT scan
Ultrasound of the arteries involved
Head MRI/MRA

An arteriography/angiography of the head may show blood vessel changes such as narrowing of the arteries.

An artery biopsy confirms the diagnosis of FMD (this is not performed on cranial blood vessels).

Treatment:

There is no known treatment for fibromuscular dysplasia.

Evaluation and treatment of hypertension (high blood pressure) associated with kidney disorders may be appropriate in some people with stroke secondary to FMD.

See Stroke.

Expectations (prognosis):

The outcome is often poor regardless of the extent of the stroke. FMD is associated with early death.

Complications:

See Stroke.

Calling your health care provider:

Go to the emergency room or call the local emergency number (such as 911) if symptoms occur.

Prevention:

Awareness of personal or family history of FMD can allow earlier diagnosis of the cause of stroke and can avoid damage caused by inappropriate treatment.

Review Date: 7/28/2002
Reviewed By: Elaine T. Kiriakopoulos, M.D., MSc, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA. Review provided by VeriMed Healthcare Network.

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