Stroke Secondary to Fibromuscular Dysplasia

Ashwin Sidhu, Harrison Chu
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Abstract

FMD is a rare systemic vascular disease characterized by abnormal cell proliferation in the artery walls, leading to artery narrowing, twisting, or bulging. It commonly affects the carotid and renal arteries and can result in renal diseases and stroke. This paper presents a case study of a 39-year-old unhoused female patient who experienced a stroke secondary to fibromuscular dysplasia (FMD) and left ventricular thrombus. The patient presented with asymmetric movement of the extremities and psychosis, so intoxication was initially suspected. However, further examination revealed facial asymmetry and motor weakness. CT scans showed a left anterior cerebral artery infarction and irregular contour of the cervical internal carotid arteries, consistent with FMD and carotid thrombus. Management involved stabilizing the patient, providing supportive treatment, and controlling blood pressure. Thrombolytic therapy was not administered due to the time elapsed since symptom onset. The patient was started on anticoagulation for the carotid plaque and left ventricular thrombus. A transthoracic echocardiogram revealed a large left ventricular thrombus and left atrial enlargement, and the patient was started on heart failure medications. FMD and left ventricular thrombus are not directly related, but FMD can contribute to thrombus development through its impact on the cardiovascular system, including hypertension, arterial wall damage, aneurysm development, or dissection. Treatment for FMD may involve medication, observation, or surgical interventions like angioplasty and stenting. Anticoagulation therapy is essential for managing the left ventricular thrombus. This case highlights the importance of early diagnosis and treatment of FMD to prevent complications such as stroke. It is important to consider FMD in the diagnosis of younger patients with a stroke, especially those with a history of hypertension, substance abuse, or other risk factors. Further research is needed to better understand the relationship between FMD and stroke and to optimize treatment strategies for these patients.
继发于纤维肌发育不良的中风
FMD是一种罕见的全身性血管疾病,其特征是动脉壁细胞异常增殖,导致动脉狭窄、扭曲或膨出。它通常影响颈动脉和肾动脉,并可能导致肾脏疾病和中风。本文介绍了一例39岁未使用的女性患者的病例研究,该患者经历了继发于纤维肌发育不良(FMD)和左心室血栓的中风。患者表现为四肢不对称运动和精神病,因此最初怀疑是中毒。然而,进一步检查发现面部不对称和运动无力。CT扫描显示左前大脑动脉梗死,颈颈内动脉轮廓不规则,与FMD和颈动脉血栓一致。管理包括稳定患者、提供支持性治疗和控制血压。由于症状出现后经过了一段时间,因此未进行溶栓治疗。患者开始接受颈动脉斑块和左心室血栓的抗凝治疗。经胸超声心动图显示有大的左心室血栓和左心房扩大,患者开始服用心力衰竭药物。FMD和左心室血栓没有直接关系,但FMD可以通过对心血管系统的影响促进血栓的发展,包括高血压、动脉壁损伤、动脉瘤发展或夹层。FMD的治疗可能包括药物治疗、观察或手术干预,如血管成形术和支架植入术。抗凝治疗对于治疗左心室血栓至关重要。该病例强调了FMD早期诊断和治疗对预防中风等并发症的重要性。在诊断年轻的中风患者时,尤其是那些有高血压、药物滥用或其他危险因素病史的患者时,考虑FMD是很重要的。需要进一步的研究来更好地了解FMD与中风之间的关系,并优化这些患者的治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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