From the Departments of Neurology (J.J., N.C., S.J., M.S.-V., D.S., S.O.), Radiology (M.M.), Vascular Surgery (J.-L.H.), and Pathology (L.D.), Fort-de-France University Hospital, Martinique, French West Indies.
Published: December 2014
AI Article Synopsis
Article Abstract
Background And Purpose: An atypical form of fibromuscular dysplasia located in the internal carotid-bulb (CaFMD) is thought to be uncommon and is poorly described as a cause of ischemic stroke in the young. This study aimed to obtain a better description of CaFMD in Afro-Caribbean population, who could be particularly affected by it.
Methods: This study included consecutive patients <55 years consulting at Fort-de-France University Hospital Stroke Center (Martinique, FWI) found to have CaFMD as the only cause after a comprehensive work-up. CaFMD was diagnosed when computed tomographic angiography showed a bulbar spur without calcification.
Results: Twenty-five patients with stroke and CaFMD were identified. Computed tomographic angiography showed 2 CaFMD patterns: a thin (n=15) or thick (n=10) spur. Three patients initial computed tomographic angiography images showed a mural thrombus overlying the CaFMD. CaFMD was surgically removed from 7 of 25 and 20 of 25 patients who received antiplatelet therapy; after mean follow-up of 25.3±19.5 months, their respective recurrence rates were 0% and 30%.
Conclusions: CaFMD could be a common condition in young Afro-Caribbeans with carotid-territory ischemic stroke. Recurrences were frequent under antiplatelet treatment, while surgical CaFMD removal seemed more effective.
The carotid web is a rare fibromuscular dysplasia disease of the internal carotid artery wall. It is a cause of thromboembolic stroke in a demographic of patients generally younger than those with atherosclerotic carotid artery disease. It is easy to miss the diagnosis without a high index of suspicion.
Renal artery stenosis (RAS) is a condition where the renal artery is narrowed by 60% or more, most commonly due to atherosclerotic plaques, affecting 5-10% of the population; rare causes include fibromuscular dysplasia and vasculitis.
The standard diagnostic method for RAS is digital subtraction angiography (DSA), but other imaging techniques like Doppler ultrasonography and CT angiography are also important.
Treatment typically involves percutaneous transluminal angioplasty (PTA), and a case study highlights a 19-year-old patient who benefitted from using a paclitaxel-coated balloon to restore renal artery function and reduce hypertension.
* Postmortem examinations showed that the manatee suffered from various health issues, including aortic stenosis, left ventricular hypertrophy, and a plastic bag lodged in its esophagus, alongside cold stress symptoms.
* Blood tests indicated systemic inflammation and potential coagulation problems, while heart-related findings included severe cardiac abnormalities; however, the exact cause of these cardiovascular issues remains undetermined.
Renal artery stenosis (RAS) and mid-aortic syndrome (MAS) are important but often overlooked causes of high blood pressure in children, with RAS involving the narrowing of renal arteries and MAS affecting the abdominal aorta and associated vessels.
These conditions can arise from genetic issues and other factors like fibromuscular dysplasia and Takayasu arteritis, making their symptoms complicated and hard to diagnose despite improved imaging techniques.
Treatment varies from medications that only partially control blood pressure to more invasive options like angioplasty and surgery, and the article emphasizes the need for a multidisciplinary approach and early detection to improve treatment outcomes for affected children.
