Abstract
A 42-year-old right-handed woman with a 7-year history of high blood pressure had a sudden onset of hemiparesis and hemihypesthesia on her right side. These symptoms were predominant in the lower extrimity. A CT scan which was examined on the following day showed multiple low density areas in the territory of the left anterior cerebral artery (ACA), which suggested cerebral infarctions. Cerebral angiography revealed changes of so-called “string of beads” appearance in the cerevical portion of the left internal carotid artery (ICA), the A2 portion of the left ACA and the foramen magnum portion of the left vertebral artery (VA), which are known as characteristic findings of fibromuscular dysplasia (FMD). Her ischemic attack was attributed to the lesion of FMD in the left ACA. In addition, the appearance of “tubular stenosis with aneurysmal dilatation” and “diverticulum-like outpouching” were found in the cervical portion of the left VA, and multiple fusiform aneurysm were confirmed in the cervical portion of the left ICA, the cervical portion of the right VA, and the right superior cerebellar artery (SCA). However occlusion or stenosis of the branches of left ACA were absent. Treated conservatively, symptoms had gradually improved. One month after admission she returned to her duties as a housewife without neurological deficit.
This patient had interesting rare lesions, namely FMD of the ACA and fusiform aneurysm of the SCA, and coexistence of both lesions hasn't been reported in the literature thus far. We are discussing intracranial FMD, and the relationship between FMD and fusiform aneurysm in review of the literatures.
