Progressive cervicocranial arteriopathy with dilatations and stenoses: case report

Abstract

-We report the case of a 36 year-old woman who presented occlusion of a basilar artery fusiform aneurysm (FA) associated with pontine infarction, and two episodes of subarachnoid hemorrhage possibly due to arterial dissection. She also had asymptomatic FAs in the right middle cerebral and left internal carotid arteries. Over 5 years, lesions suggestive of fibromuscular dysplasia in the right vertebral artery and occlusion of the left vertebral artery were observed. This combination of lesions emphasizes the possibility of a common pathogenetic mechanism causing different degrees of media disruption in cervicocranial arteries.KEY WORDS: arterial cervicocranial disease, fusiform aneurysms, fibromuscular dysplasia, arterial dissection, subarachnoid hemorrhage. Arteriopatia progressiva com dilatações e estenoses: relato de casoRESUMO -Relatamos o caso de uma doente de 36 anos que apresentou oclusão de um aneurisma fusiforme de artéria basilar associado a infarto pontino e dois episódios de hemorragia subaracnóide provavelmente devido a dissecção arterial. Ela também apresentava aneurismas fusiformes assintomáticos na artéria cerebral média direita e na artéria carótida interna esquerda. Ao longo de 5 anos, lesões compatíveis com displasia fibromuscular foram observadas na artéria vertebral direita, assim como oclusão da artéria vertebral esquerda. Esta combinação de lesões sugere que um mecanismo etiopatogênico comum tenha causado diferentes graus de comprometimento da camada média de artérias cervicocranianas. PALAVRAS-CHAVE: doença arterial cervicocraniana, aneurisma fusiforme, displasia fibromuscular, dissecção arterial, hemorragia meníngea.

Multicenter studies to shed light on fibromuscular displasia and cervical artery dissection

“…It has been suggested that, even though FMD was previously considered to be rare, it may occur in 4% of adult women, being asymptomatic in most cases 2 . FMD is associated with a greater prevalence of intracranial aneurysms, as previously reported in this journal 4 , and with a greater risk of arterial dissection. The prevalence of FMD in the general population is not known, as well as mechanisms underlying pathogenesis of this vascular disease, or effective treatment strategies.…”