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Fibromuscular Hyperplasia of the Carotid Artery

Fibromuscular Hyperplasia of Carotid Artery


Presentation

  • We present a case where long stenoses of both internal carotid arteries were associated with terminal carotid occlusions and a ruptured basilar aneurysm.[ncbi.nlm.nih.gov]
  • These changes were not present on the previous angiogram.[cureus.com]
  • The most accurate diagnosis comes from combining clinical presentation and angiographic imaging.[en.wikipedia.org]
  • By comparison, this patient did not present with an active herpetic infection, and no evidence was present of an inflammatory response.[ispub.com]
  • There are less than 15 histologically confirmed cases of intimal FMD presenting with ischemic stroke.[article.sapub.org]
Physician
  • He is a Fellow of the American Academy of Neurology, American Neurological Association, American College of Physicians, and the Stroke Council of the American Heart Association.[books.google.de]
  • Physicians will monitor patients’ medications and assess signs of possible recurrence. Back to Top[massgeneral.org]
  • Learn about the exceptional experience of the Inova Heart and Vascular physicians and their work with carotid artery disease[inovaheart.org]
  • Physician Referrals - Call 800.659.7822 (or call physicians’ office directly).[my.clevelandclinic.org]
  • This should be done together with a physician experienced in blood pressure control during pregnancy. Teratogenicity should be avoided. Exclude vascular complications.[angiologist.com]
Epilepsy
  • Rebecca now has aphasia, dyspraxia, homonymous hemianopia, severe left side weakness, epilepsy, severe stomach pains, and due to fatigue, she has frequent pyjama days.[fmdchat.blogspot.com]
Thyroid Nodule
  • A known left-sided thyroid nodule was stable. The differential diagnosis of amaurosis fugax is extensive and can be divided into circulatory, ocular, and neurologic etiologies (Table 1 ).[thoracickey.com]
Noncompliance
  • Antiplatelet agents Smoking cessation or other risk factor modification Endovascular therapy or surgery indicated if: Hypertension is poorly controlled despite maximum doses of three antihypertensive medications Patient is unable to tolerate medications or is noncompliant[pathologyoutlines.com]
Carotid Bruit
  • She was initially seen by an ophthalmologist who noted a normal eye exam with intact visual fields, but identified a left carotid bruit. Her past medical history was important for sicca syndrome, hyperlipidemia, and mitral valve prolapse (MVP).[thoracickey.com]
  • Examination may reveal neurological deficits, Horner's syndrome (half of cases), hemiparesis, carotid bruit.[patient.info]
  • No audible carotid bruit was heard. However, a grade 2/6 systolic murmur was prominent at the left costal margin. Cranial nerves II through XII were intact bilaterally.[ispub.com]
Enophthalmos
  • Carotid artery dissection is a strong consideration, particularly when headache and/or neck pain is reported or Horner’s syndrome symptoms (ptosis, miosis, anhidrosis, and enophthalmos) are present.[thoracickey.com]
Anisocoria
  • Cranial nerve examination showed anisocoria (diameter of pupils; right: 2.5 mm, left: 4 mm).[indjvascsurg.org]
Anhidrosis
  • Carotid artery dissection is a strong consideration, particularly when headache and/or neck pain is reported or Horner’s syndrome symptoms (ptosis, miosis, anhidrosis, and enophthalmos) are present.[thoracickey.com]
Stroke
  • Gain fresh perspectives and up-to-date insights from the world’s leading authorities on the pathophysiology, diagnosis, and management of stroke.[books.google.de]
  • He is a Fellow of the American Academy of Neurology, American Neurological Association, American College of Physicians, and the Stroke Council of the American Heart Association.[books.google.de]
  • Stroke 2014;45:37-41. DOI PubMed 11.[nnjournal.net]
  • He was discharged on day 21 without any neurologic sequelae, and aspirin (81 mg daily) was prescribed for primary stroke prevention. Figure 1: (a) Stroke-in-evolution. (b) Active intracranial hemorrhage with a midline shift.[indjvascsurg.org]
  • Patients with FMD who present with stroke or carotid dissection should be admitted to a stroke unit and anticoagulation treatment should be started[2, 3, 14].[article.sapub.org]
Babinski Sign
  • A neurological examination revealed somnolent, neck stiffness, and bilateral Babinski’s sign. The rest of the physical examination was detected to be normal. There was no personal or family history of hypertension and cerebrovascular events.[omicsonline.org]
  • The positive neurological signs were as follows: incomplete logaphasia, central facial paralysis, right-sided hemiparesis (4/5) and positive Babinski sign.[nnjournal.net]

Workup

  • Further workup was done to confirm the diagnosis of FMD, and magnetic resonance angiography of the carotid arteries revealed a “string of beads” appearance in the right internal carotid artery, which confirmed the diagnosis of FMD.[cureus.com]
  • See Workup for more detail. Management Partly because of the unknown etiology of FMD, no curative therapy exists. Fortunately, FMD is often benign when asymptomatic, and medical treatment is not indicated.[emedicine.medscape.com]
  • […] are located more distally and extend into the distalbranches or parenchyma of the kidney.In this retrospective study we summarize experiencefrom a referral center for complicated renal vascular disease.Included are clinical presentation, diagnostic workup[docslide.com.br]
Mural Thrombus
  • Carotid Dopplers were negative for bifurcation plaque, and a transthoracic echocardiogram (TTE) did not demonstrate valve vegetations or mural thrombus.[thoracickey.com]
ST Elevation
  • An electrocardiogram (EKG) obtained at an outlying facility showed ST elevations in lead II, aVF, V5 and V6 consistent with ST elevation myocardial infarction (STEMI) (Figure 1 ).[cureus.com]
T Wave Inversion
  • An EKG revealed ST elevations in lead I, aVL, V5-V6, ST depressions in V1-V3, and T-wave inversion over V2-V5 (Figure 4 ). The troponin I level increased to 40 ng/ml (normal 0.0 to 0.04 ng/ml).[cureus.com]

Treatment

  • Access the comprehensive, expert clinical guidance you need to recognize the clinical manifestations of stroke, use the latest laboratory and imaging studies to arrive at a diagnosis, and generate an effective medical and surgical treatment plan.[books.google.de]
  • This case report documents the diagnosis and treatment of a large carotid artery aneurysm (4 cm) associated with fibromuscular hyperplasia of the internal carotid artery.[ncbi.nlm.nih.gov]
  • Abdominal-Pelvic Venous Disease: Surgical Treatment 62. Abdominal-Pelvic Venous Disease: Endovascular Treatment 63. Superior Vena Cava Obstruction: Surgical Treatment 64. Superior Vena Cava Occlusion: Endovascular Treatment 65.[euro-libris.ro]
  • 3 of them underwent endovascular treatment (Fig. 9 ).[cardiovascularultrasound.biomedcentral.com]
  • These lesions require careful planning for treatment.[med.stanford.edu]

Prognosis

  • Prognosis [ edit ] Prognosis and outcome research is scant. In some cases if not managed properly FMD-related aneurysms can occur causing bleeding into the brain, resulting in stroke, permanent nerve damage, or death.[en.wikipedia.org]
  • […] allows assessment of end-organ ischemic damage. typical angiographic features include: vascular loops, fusiform vascular ectasia and a string of beads less typical features include: arterial dissection, aneurysm and subarachnoid hemorrhage Treatment and prognosis[radiopaedia.org]
  • Although the pathophysiology of FMD)is not known, smoking has been implicated as a potential contributing factor and portends a worse prognosis.[emedicine.medscape.com]
  • […] in their 50 s (mean age 51.9 years) for arteries supplying the head and neck, heart, kidneys, and pelvis to prevent catastrophic complications because FMD is autosomal dominant. [5], [6] This case demonstrates that such patients may have a favorable prognosis[indjvascsurg.org]
  • Because the overall long-term prognosis of fibro muscular dysplasia of the cervico-cephalic arteries is quite good and this patient does not present any other downstream adverse vascular events, conservative treatment with periodical follow-up was given[omicsonline.org]

Etiology

  • FMD was suspected as an underlying etiology of SCAD in this young female with no traditional risk factors for atherosclerotic disease.[cureus.com]
  • Fibromuscular Dysplasia Fibromuscular Hyperplasia, FMH Submitted by Ab Shrivastava, MD General Considerations Incidence 0.6% via angiography 1.1% via autopsy Female to male ratio 3:1 Presenting age 25-50 Pathology Developmental lesion of unknown etiology[learningradiology.com]
  • Its etiology is unknown. The arteries other than renal and carotid to be involved are vertebral, lumbar, mesenteric, celiac, hepatic and iliac arteries.[sonoworld.com]
  • The differential diagnosis of amaurosis fugax is extensive and can be divided into circulatory, ocular, and neurologic etiologies (Table 1 ).[thoracickey.com]
  • Although the etiology of FMD is unknown, several other associated vascular pathologies have been identified.[emedicine.medscape.com]

Epidemiology

  • Epidemiology Age of onset : typically 30–50 years ;, but can manifest at any age Sex : ( 8:1 ) Ethnicity : increased prevalence among the white population References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Hopefully, we will be able to better understand the epidemiology of the disease, clinical characteristics, and management.[cathlabdigest.com]
  • Epidemiology and Clinical Analysis 2. Embryology 3. Vessel Wall Biology 4. Cells of the Vascular System 5. Atherosclerosis 6. Intimal Hyperplasia 7. Ischemia-Reperfusion 8. Arteriogenesis and Angiogenesis 9.[euro-libris.ro]
  • […] vascular bed involvement, vascular procedures, and clinical outcomes of patients with FMD. 8,9 Table 1 highlights key findings and lessons learned from registry publications, many of which have altered previous concepts of this disease. 3,7,8,10–12 EPIDEMIOLOGY[mdedge.com]
  • Although the multiple manifestations of a structural arteriopathy in FMD hint of a genetic cause, such as collagen or elastin mutation, epidemiologic data suggesting familial transmission are generally weak.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Gain fresh perspectives and up-to-date insights from the world’s leading authorities on the pathophysiology, diagnosis, and management of stroke.[books.google.de]
  • Pathophysiology Fibromuscular dysplasia (FMD) is an idiopathic, non-inflammatory, non-atherosclerotic, developmental condition that primarily affects small and medium-sized muscular arteries.[amboss.com]
  • Although the pathophysiology of FMD)is not known, smoking has been implicated as a potential contributing factor and portends a worse prognosis.[emedicine.medscape.com]
  • Arterial Aneurysms Section 2: Pathophysiology 10. Arterial Physiology 11. Venous Physiology 12. Venous Pathology 13. Lymphatic Pathophysiology Section 3: Clinical and Vascular Laboratory Evaluation 14. Patient Clinical Evaluation 15.[euro-libris.ro]
  • […] involvement, vascular procedures, and clinical outcomes of patients with FMD. 8,9 Table 1 highlights key findings and lessons learned from registry publications, many of which have altered previous concepts of this disease. 3,7,8,10–12 EPIDEMIOLOGY AND PATHOPHYSIOLOGY[mdedge.com]

Prevention

  • Stay up to date on hot topics such as mechanisms of action of commonly used drugs, neuronal angiogenesis and stem cells, basic mechanisms of spasm and hemorrhage, prevention of stroke, genetics/predisposing risk factors, and much more.[books.google.de]
  • Segmental resection and autogenous graft reconstruction of the carotid artery were successful in removing the lesion and preventing subsequent symptoms.[ncbi.nlm.nih.gov]
  • These measures were expected to provide excellent long-term patency and help prevent strokes in the future.[indjvascsurg.org]
  • HDL is the “good” cholesterol that helps prevent coronary heart disease.[surgery.ucsf.edu]
  • Your doctor may prescribe medications to prevent your blood from clotting and to help prevent a stroke.[vascularpavilion.com]

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