A 39-year-old diabetic male patient with a history of right-eye amaurosis fugax presented with recurrent episodes of left-sided weakness. MRI of the brain revealed chronic infarcts in the right frontoparietal lobe. Conventional cerebral angiogram showed moderate-to-severe stenosis of the entire right internal carotid artery with diffuse beaded appearance highly suggestive of fibromuscular dysplasia (FMD) (Figure). MR angiography of the chest, abdomen, and pelvis was normal. He was initiated on aspirin 100 mg once daily with strict control of diabetes mellitus and dyslipidemia. FMD is a rare idiopathic nonatherosclerotic, noninflammatory vasculopathy affecting the musculature of small and medium-sized arteries primarily leading to stenosis and occasionally arterial dissection, aneurysms, and tortuosity.1,2 Atypical features in our patient included male sex and isolated multifocal cerebrovascular FMD with predominant intracranial involvement (Figure).
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- Received May 5, 2022.
- Accepted in final form August 22, 2022.
- © 2022 American Academy of Neurology