Fibromuscular dysplasia (FMD) - stroke secondary to

Definition

Stroke secondary to fibromuscular dysplasia (FMD) is an interruption of blood flow to the brain due to problems with the structure of the arteries that supply the brain with blood.

Alternative Names

Causes

A stroke is an interruption of the blood supply to any part of the brain. 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 (scar-like) tissue in the wall of the affected arteries, which alternate with enlarged (dilated) areas of destroyed tissue. This irregularity in the arteries increases the risk for stroke.

The disease may affect the neck arteries (carotids) that supply blood to the brain, 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, tingling or other abnormal sensations
• Decreased or lost vision, partial or temporary
• Language difficulties (aphasia)
• Inability to recognize or identify visual cues (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:
  • Sleepiness
  • Stupor, lethargy
  • Coma, loss of consciousness

Exams and Tests

The exact location and extent of the stroke, and changes in the arteries indicating FMD may be seen on:

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

An arteriography or 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 brain blood vessels).

Treatment

Stroke is a serious condition. The sooner treatment is received, the better the person will do, and the lower the chance of permanent disability or death. Treatment depends on the severity of the stroke and its affects.

Careful monitoring can reveal problems with the arteries before injury occurs. In some circumstances, surgery to repair any blockages can prevent complications.

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

Outlook (Prognosis)

The outcome from any stroke depends on the initial severity, and ability to treat it quickly. Although FMD is associated with an increased risk of stroke and other complications, many patients can do well with good treatment and close attention to any secondary complications. As with other types of stroke, strokes from FMD can result in death or severe disability. Complete or significant recovery from a stroke is also possible.

Possible Complications

• Problems due to loss of mobility (joint contractures, pressure sores)
• Permanent loss of movement or sensation of a part of the body
• Bone fractures
• Muscle spasticity
• Permanent loss of brain functions
• Reduced communication or social interaction
• Reduced ability to function or care for self
• Decreased life span
• Side effects of medications
• Aspiration
• Malnutrition

When to Contact a Medical Professional

Stroke is a medical emergency. Immediately go to the emergency room or call the local emergency number (911 in the United States) if signs of a stroke occur.

Prevention

Awareness of personal or family history of FMD can allow earlier diagnosis of the cause of stroke.

Aspirin therapy (81mg a day or 100mg every other day) is now recommended for stroke prevention in women under 65 as long as the benefits outweigh the risks. It should be considered for women over age 65 only if their blood pressure is controlled and the benefit is greater than the risk of gastrointestinal bleeding and brain hemorrhage

Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.