FMD could be cause of stroke
DEAR DR. GOTT: I am an active 58-year-old female, 5 feet 6 inches and 119 pounds. I had Grave’s disease, for which medication was ineffective, so I was given radioactive iodine, which eliminated my thyroid. I now take Levoxyl as well as full-strength aspirin and a daily multivitamin. My father died at age 57 of a stroke. He also had asthma and high blood pressure. My mother passed away from cancer and had adult-onset diabetes.
Out of the blue, while driving with my husband to our daughter’s house three hours away, I suddenly had split vision. A horizontal black line appeared in the middle of my vision with a picture on top and one on the bottom. It was very disconcerting, and I knew something very bad had happened, although the incidence only lasted about two minutes.
I called my physician in my hometown who thought everything was OK since my “numbers” (cholesterol, blood pressure, etc.) had always been very good, but he told me to come in and see him the following week when I returned home.
He ordered an MRI and an MRA, which showed that I had suffered a stroke and also have fibromuscular dysplasia in my neck. Because he was unfamiliar with the dysplasia, he sent me to a neurologist, who doubted the diagnosis because fibromuscular dysplasia typically occurs in younger people. To confirm the diagnosis, he sent me for a CT angiography, which showed I did indeed have it in the right internal carotid artery.
I was told there was no definitive treatment and that it may progress rapidly or slowly, although he thought in my case it would be slow. I was also told that my particular case wasn’t considered severe because there was no bulging and there was otherwise good flow through the arteries. The neurologist passed his recommendations on to my regular physician for periodic follow-up to include Doppler studies and ultrasounds.
Can you tell me more about fibromuscular dysplasia? Could my Grave’s, the radioactive iodine or the Levoxyl have contributed to this? Thank you.
DEAR READER: Fibromuscular dysplasia (FMD) is a condition in which one or more arteries develop an abnormal cluster of cells within the artery wall. The cell cluster causes narrowing, which reduces blood flow and may lead to organ damage. It most commonly affects premenopausal women between the ages 14 and 50 but may also be found in young adult men and older women.
FMD typically affects the renal arteries that supply the kidneys but may also be found in arteries that lead to the arms, legs, abdomen or brain. About 25 percent of those with FMD will have more than one narrowed vessel and while there is no cure, there are effective treatments.
Symptoms vary depending on which arteries are affected. If the abdominal arteries are involved, you may experience unintended weight loss or pain after eating. If the renal arteries are affected, you may experience neck pain, blurred vision or temporary loss of vision, dizziness, high blood pressure, chronic headaches, tinnitus, chronic kidney failure or ischemic renal atrophy (tissue death). If the peripheral arteries (arms and legs) are affected, you may experience weakness, numbness, cold limbs, discomfort when moving the limbs or changes in skin color or appearance.
There is no known cause, but it is believed that several factors may play a role, including hormones, abnormally formed arteries and genetics.
Treatment depends on the severity and location of the FMD as well as a person’s overall health. Medication is typically recommended and include ace inhibitors, calcium channel blockers and beta blockers, which are all medications prescribed for high blood pressure.
Many people who are otherwise healthy often undergo surgical repair of the affected artery or arteries and are often advised to take medication following surgery as a precaution. The most frequently recommended procedure is percutaneous transluminal renal angioplasty (PTRA), which essentially uses a balloon catheter to expand the narrowed section(s) of artery. Stents are not typically required to keep the vessel open. The last option is surgical revascularization. This procedure is used when PTRA is not an option, such as when the arteries are severely narrowed. There are several variations of this surgery depending on the location of the affected artery and the amount of damage present.
Return to your general physician, and request a referral to a cardiovascular surgeon or specialist who is familiar with the treatment of FMD. Clearly, your neurologist was not familiar enough with the condition to offer you advice regarding treatment.