Extracranial internal carotid fibromuscular dysplasia associated with successfully treated hyperacute cerebral infarction

ABSTRACT

Fibromuscular dysplasia [FMD] is a segmental non-atheromatous and non-inflammatory stenosing angiopathy of unknown cause and the cervico-cephalic [cc] FMD is relatively uncommon. The big majority of the ccFMD patients are Caucasians and there have been several reports in Japan up to the present, the greatest number of which were associated with intracranial aneurysms or discovered post-mortem. The association with cerebral infarction has been rarely described in Japanese patients. We report a case of hyperacute cerebral ischemia caused by embolism, originating in the internal carotid artery. We performed super-selective thrombolysis of a middle cerebral artery embolic ooclusion by a microcatheter with excellent result. Although ccFMD can be associated with a range of vascular pathology and cerebral ischemia is only one of the possibilities, it should be considered as a cause in these young patients where there is no evidence of other embolic sources. Early intervention in these cases can prevent ischemic brain damage