Spontaneous Bilateral Carotid Artery Dissection Revealing Multifocal Fibromuscular Dysplasia

W Bnouhanna,S Aïdi,M Benabdeljlil,W Fakir,M Rahmani

doi:10.4236/crcm.2019.89031

Abstract

Background: Fibromuscular dysplasia (FMD) is a rare idiopathic segmental non-arteriosclerotic and non-inflammatory arterial disease of small to medium-sized vessels. Although it is considered a benign entity, FMD can lead to potentially severe cerebrovascular complications. We present an atypical clinical case of ischemic stroke (IS) caused by bilateral carotid dissection revealing multifocal FMD. Case Report: A 43-year-old right-handed female with no medical history suddenly developed somnolence with left-sided weakness. Clinical examination revealed left hemiplegia and left central facial paralysis with an NIHSS score: 22. Cerebral tomography (CT) with arterial angiogram revealed abilateralis of the middle cerebral arteries (MCA), a double dissection of the internal carotids (IC), aneurysmal ectasia of the left IC, and aneurysm of the M2 segment of the MCA. Brain magnetic resonance imaging (MRI) with arterial angiography confirmed the bilateral dissection. A cerebral angiography (CA) revealed a radiological pattern of multifocal FMD. The angiography of the aorta and its branches showed adiffuse dysplasia of the renal arteries. The patient was put under antiaggregants. The modified Rankin score (mRS) after three months was three. Conclusion: Cerebrovascular FMD has typical angiographic features, the “string of beads” appearance being the most common. Although the risk of a stroke in patients with cervical FMD is low, it can lead to a severe stroke and the long-term risks are unknown. Patient registries should be encouraged to better understand the mechanisms and evolutionary profile of FMD and alert clinicians to this potentially disabling condition.

Highlights

Fibromuscular dysplasia (FMD) is a rare idiopathic segmental non-arteriosclerotic and non-inflammatory arterial disease of small to medium-sized vessels
We present an atypical and rare clinical case of ischemic stroke (IS) caused by bilateral carotid dissection revealing multifocal Fibromuscular dysplasia (FMD at internal carotid and renal artery with an intracranial aneurysm)
Brain magnetic resonance imaging (MRI) with arterial angiography and T1 FAT-SAT cervical axial section confirmed the bilateral dissection of the cervical carotids predominant on the right, associated with bilateral IS in the capsular-lenticular territory and the superficial territory of the right middle cerebral arteries (MCA) (Figure 1)

Summary

Introduction

Fibromuscular dysplasia (FMD) is a rare idiopathic segmental non-arteriosclerotic and non-inflammatory arterial disease of small to medium-sized vessels. The renal and cervical arteries are the most commonly affected, but all arterial territories can be involved. The cause and pathophysiology of FMD are still unknown. Clinical manifestations of FMD are primarily dependent on the affected vessels. FMD is usually considered as a relatively benign disease, cervical FMD can lead to potentially serious cerebrovascular complications. We present an atypical and rare clinical case of ischemic stroke (IS) caused by bilateral carotid dissection revealing multifocal Fibromuscular dysplasia (FMD at internal carotid and renal artery with an intracranial aneurysm)

Case Report

Discussion

Findings

Conclusion

Conflicts of Interest