Do I need follow up for fibromuscular dysplasia?


Q: I was diagnosed with fibromuscular dysplasia 10 years ago when i tried to donate a kidney. When I told my G.P. About it, he just shrugged. I am not having any problems now but wonder if i should ask for any follow up on this condition?


A:   If you have symptoms, absolutely. Fibromuscular Dysplasia (FMD) is a problem of the vessels that affects medium-sized arteries predominantly in young women of childbearing age. FMD most commonly affects the renal arteries and can cause high blood pressure. It can affect brain arteries and arteries of the extremities too. Most people are asymptomatic, but in the case to have symptoms these may be: headache, lightheadedness, vertigo if the brain arteries are affected. Because of the broad possibilities of neurologic dysfunction due to stroke caused by FMD, a thorough neurologic examination should be performed. Findings may include anything from cranial nerve deficits to weakness, numbness, and coordination difficulties. Because of the systemic nature of FMD, the general physical examination should include a search for signs of renal, visceral, and limb arterial involvement. These signs may include hypertension, decreased peripheral pulses, and even asymmetric limb pressures. Fortunately, FMD is often benign when asymptomatic, and medical treatment is not indicated. But in the case that you start to have hypertension you should be evaluated by a nephrologist and possibly considered for vascular intervention. Also if you have a transient ischemic attack (TIA), it is recommended a complete neurological evaluation including a cerebral angiography, which is the investigation of choice to detect not only FMD but also arterial dissection, vasculitis, and aneurysms, which are other major etiologies of stroke.

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