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Objective: To present a rare or unusual manifestation of fibromuscular dysplasia (FMD) and highlight the diagnostic challenges encountered in identifying fibromuscular dysplasia, particularly in uncommon presentations. Design and method: CASE REPORT: 35/F, Kerala Tribal ethnicity, P2L2A0 H/O. HTN x 10 years on irregular indigenous medications. Presented to the ER with seizures followed by sudden onset right hemiplegia and slurring of speech. Initial assessment: Patient conscious, obeying commands. P- 130/min regular, BP - 216/120 mm Hg, Rt side- zero power with extensor plantar. CT Brain -Acute ICH 30x17 mm in Left insular cortex with surrounding edema. Admitted to the ward for young stroke evaluation. Past H/O: Intermittent headaches, pulsatile tinnitus and flank pain. Addicted to tobacco and ethanol, Normal bowel no evidence of thrombus. CTA: B/L small sized kidneys with diffusely narrow caliber of both renal arteries with relative sparing of proximal portion. No ostial stenosis or beading of vessels seen. Aorta and its branches appear normal. Management: Losartan, Chlorthalidone, Amlodipine, Smoking cessation Conclusions: Unlike atherosclerotic disease, which localizes at ostial and proximal segments of renal arteries, FMD more commonly involves the middle and distal arterial segments. FMD classically presents as renovascular hypertension but can also manifest as stroke in young adults. Our patient had focal FMD corresponding to Intimal fibroplasia histopathological variant.
Sreenath et al. (Wed,) studied this question.