Stroke secondary to FMD

Alternative names
Fibromuscular dysplasia - stroke secondary to

Definition
Stroke secondary to FMD is an interruption of blood flow to the brain due to deformities in arteries supplying the brain.

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 of destroyed tissue. 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, 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:       o Sleepiness       o Stupor, lethargy       o Coma, loss of consciousness

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 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 cranial blood vessels).

Treatment
Careful monitoring can disclose problems with the arteries before injury occurs. In some circumstances, blockages can be surgically corrected to 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.

Expectations (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 optimal mangement and close attention to any secondary complications. As with other types of stroke, strokes from FMD can result in death, severe disability, or complete recovery.

Complications
See stroke.

Calling your health care provider
Go to the emergency room or call 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.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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