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Ismail M, Al-Ageely TA, Alzerkani MAA, Al-Khazaali YM, Salih HA, Al-Khafaji AO, Kareem ZM, Abdulsada AM, Salih HR, Hoz SS. Extracranial carotid localized fibromuscular dysplasia: A case report and literature review. Surg Neurol Int 2022; 13:498. [DOI: 10.25259/sni_937_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Fibromuscular dysplasia (FMD) is a noninflammatory and nonatherosclerotic arteriopathy that is characterized by irregular cellular proliferation and deformed construction of the arterial wall that causes segmentation, constriction, or aneurysm in the intermediate-sized arteries. The incidence of FMD is 0.42–3.4%, and the unilateral occurrence is even rarer. Herein, we report a rare case of a localized extracranial carotid unilateral FMD associated with recurrent transient ischemic attacks (TIAs) treated by extracranial-intracranial bypass for indirect revascularization. The specific localization of the disease rendered our case unique.
Methods:
We conducted a review of the PubMed Medline database search using the following combined formula: ((FMD [Title/Abstract]) AND ((isolated [Title/Abstract]) OR (localized [Title/Abstract]))) AND Internal carotid artery (ICA) (Title/Abstract). Additional resources were included by screening the reference list of the selected papers.
Results:
A total of six cases were found, and all accounted for localized FMD affecting the ICA. The age range was between 19 and 52, the male-to-female ratio was (2:4), and all of the cases consisted of unilateral carotid FMD, mainly on the left side with a left-to-right ratio of 5:1. The management and outcome of these cases varied according to the case and associated complications.
Conclusion:
Extracranial localized FMD of the ICA is a rare subtype of FMD that has little documentation in the literature. In our case, it was a localized extracranial carotid unilateral FMD associated with recurrent TIAs. The appropriate treatment was using the intracranial-extracranial bypass.
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Affiliation(s)
- Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Teeba A. Al-Ageely
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | | | - Younus M. Al-Khazaali
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Haneen A. Salih
- Department of Biology, University of Al-Mustansiriyah, College of Sciences, Baghdad, Iraq,
| | - Aktham O. Al-Khafaji
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Zahraa M. Kareem
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | | | - Hayder R. Salih
- Department of Neurosurgery, Neurosurgical Teaching Hospital, Baghdad, Iraq,
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
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McDonald A. A Case of Isolated Intracranial Fibromuscular Dysplasia. Cureus 2020; 12:e8755. [PMID: 32714693 PMCID: PMC7377658 DOI: 10.7759/cureus.8755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic disease resulting in stenosis and arterial wall weakening of typically medium-sized arteries. Intracranial aneurysm is an uncommon presentation of FMD, with a significant proportion presenting in the posterior circulation. Presented is the rare case of an adult female with left-sided stroke with angiographically-confirmed left middle cerebral artery FMD, with pan-scanning unremarkable for other demonstrable evidence of FMD. The patient's neurological deficits completely resolved. The patient was stable for discharge home on antiplatelet therapy. Appropriate imaging and screening should be performed to ensure FMD is localized versus systemic. Patients with intracranial FMD should be protected from cerebrovascular events with antiplatelet therapy.
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Affiliation(s)
- Abigail McDonald
- Internal Medicine, Hospital Corporation of America Healthcare in Association with the University of South Florida Morsani College of Medicine Graduate Medical Education Programs, Northside Hospital, St. Petersburg, USA
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Yeo MJ, Jeon HY, Cha MJ, Jang HY, Lee SG, Seon Kim J, Lee SH, Lee SS, Shin DI. Isolated intracranial fibromuscular dysplasia of the posterior cerebral artery. J Clin Neurosci 2017; 43:119-121. [PMID: 28431954 DOI: 10.1016/j.jocn.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/03/2017] [Indexed: 11/20/2022]
Abstract
Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory arterial disease that most commonly affects the renal and internal carotid arteries, but intracranial FMD is very rare. We report a patient with FMD involving the posterior cerebral arteries (PCAs). A 24year old female was presented with a 4day history of right homonymous hemianopsia with throbbing headache in the left temporo-occipital area. The brain magnetic resonance imaging (MRI) revealed an acute ischemic stroke in the left PCA territory, while the Time of Flight (TOF) magnetic resonance angiogram (MRA) showed segmental luminal irregularities in the left proximal PCA. The conventional angiogram revealed the "string of beads" appearance, a characteristic that is pathognomonic for FMD. The patient's inhospital clinical course was stable, while there was no recurrence of stroke. This is the second report of FMD of the PCA. Notwithstanding incredibly rare incidences of isolated intracranial FMD and nonspecific findings of MRA, such a pathophysiology should be considered as the cause for a stroke in young patients, especially those with no cardiovascular risk factor.
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Affiliation(s)
- Min-Ju Yeo
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ho-Yeong Jeon
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Min-Ju Cha
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hye-Yeon Jang
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sang-Gil Lee
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ji Seon Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sung-Hyun Lee
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sang-Soo Lee
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea.
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Subramanian A, Aggarwal G, Agarwal D, Lalwani S. Internal Carotid Artery Fibromuscular Dysplasia in a Child: Incidental Postmortem Finding after Head Injury. J Lab Physicians 2017; 9:60-63. [PMID: 28042220 PMCID: PMC5015502 DOI: 10.4103/0974-2727.187922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a rare, segmental, nonatheromatous, and noninflammatory arterial disease of unknown etiology. It predominantly involves renal artery (60–75%) followed by extracranial part of the internal carotid artery and vertebral arteries (25–30%). The disease typically affects middle-aged women and involves intermediate-sized arteries throughout the body. There are rare case reports of extracranial FMD compounding a trauma case. A patient was brought to trauma center emergency with a history of fall from height. There were one previous episode of seizure and two episodes of vomiting. His Glasgow Coma Scale on admission was E1V1M4. Noncontrast computed tomography of the head showed fracture on the right zygomatic, temporal, and parietal bone, with underlying thin subdural hemorrhage. The patient underwent left frontotemporoparietal decompressive craniectomy and lax duraplasty with bone flap in bone bank. On the 1st postoperative day, he succumbed to his injuries despite timely surgery and necessary interventions. It was only postmortem when FMD was diagnosed in carotid artery by histopathological examination. On microscopy, intimal changes were seen in the form of expansion of subendothelial loose matrix with mesenchymal cells, thickening and hyalinization of the internal elastic lamina, areas of duplication and disruption of internal elastic lamina. Medial wall changes included thickening of the wall, focal loss of the smooth muscle, and replacement with fibrosis (dysplastic change). This case emphasizes the importance of considering this disease in the differential diagnosis of children and young adults with stroke (which subsequently lead to his fall).
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Affiliation(s)
- Arulselvi Subramanian
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Aggarwal
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agarwal
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Lalwani
- Department of Forensic Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
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Lummus S, Breeze R, Lucia MS, Kleinschmidt-DeMasters BK. Histopathologic Features of Intracranial Vascular Involvement in Fibromuscular Dysplasia, Ehlers-Danlos Type IV, and Neurofibromatosis I. J Neuropathol Exp Neurol 2014; 73:916-32. [DOI: 10.1097/nen.0000000000000113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Alurkar A, Karanam LSP, Oak SP. Corkscrew angiopathy of intracranial vessels in a young stroke patient: a case report. J Med Case Rep 2012; 6:358. [PMID: 23092123 PMCID: PMC3514127 DOI: 10.1186/1752-1947-6-358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 08/11/2012] [Indexed: 11/16/2022] Open
Abstract
Introduction We present a rare finding of a ‘corkscrew appearance’ of the distal cerebral vessels in a young Asian woman who presented with acute stroke. Case presentation A 32-year-old Asian woman presented with a 3-month history of recurrent right-sided transient ischemic attacks. Her clinical workup and brain imaging results were normal. A digital subtraction angiogram revealed an abnormal corkscrew appearance of all intracranial distal vessels. She was discharged on a single antiplatelet drug. She had no further transient ischemic attacks on clinical follow-up. A digital subtraction angiogram performed 1 year later revealed no changes in the appearance of these vessels. Conclusion To the best of our knowledge no similar previous reports exist in the literature. The present report describes a unique case of an unusual corkscrew appearance of the distal intracranial vessels. However, the underlying etiology in the present case remains unknown.
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Affiliation(s)
- Anand Alurkar
- Department of Neurointervention, KEM Hospital, Pune, India.
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Shea KJ, Hoang JK, Smith EC. Ischemic stroke because of intracranial fibromuscular dysplasia. Pediatr Neurol 2011; 44:214-7. [PMID: 21310338 DOI: 10.1016/j.pediatrneurol.2010.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 06/07/2009] [Accepted: 11/01/2010] [Indexed: 11/26/2022]
Abstract
Ischemic stroke in a 12-year-old African-American boy was caused by intracranial fibromuscular dysplasia. Imaging investigations included computed tomography and magnetic resonance angiography, before reaching a definitive diagnosis with a conventional cerebral angiogram. This pediatric case of intracranial fibromuscular dysplasia highlights the need to consider this rare disorder in the differential diagnosis of pediatric stroke and the role of imaging in establishing a diagnosis. The literature of fibromuscular dysplasia is reviewed, and other causes of pediatric stroke are discussed.
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Affiliation(s)
- Kenneth J Shea
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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