Fibromuscular Dysplasia Follow-up

Updated: Apr 03, 2017
  • Author: James A Wilson, MD, MSc, FRCPC; Chief Editor: Helmi L Lutsep, MD  more...
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Follow-up

Further Outpatient Care

Neurorehabilitation generally helps to recover function if any residual neurologic deficits are present.

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Further Inpatient Care

Physical and occupational therapy and speech therapy may be important aspects of patient care should neurologic deficits exist.

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Inpatient & Outpatient Medications

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  • As mentioned above, life-long antiplatelet agents are generally suggested if a stroke occurred because of their benefit in reducing stroke and their relatively low morbidity.
  • Given the potential pro-coagulant effects of estrogen, especially in smokers, oral contraceptives and hormonal replacement therapy is often avoided. No data exists to support or refute this strategy.
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Deterrence/Prevention

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  • Lifestyle changes that minimize the risk of vascular disease should be stressed.
  • These changes include quitting smoking, weight control, doing exercise, and eating a healthy diet.
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Complications

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  • The complications of FMD can be diverse, notably because it is a systemic vascular disease. Fortunately, most patients have relatively isolated disease, and invasive measures during follow-up are not required.
  • Blood pressure should be monitored carefully throughout the patient's lifetime because of the possibility of renovascular hypertension.
  • Any symptoms compatible with ischemia and angiographic findings should prompt consideration of FMD as the underlying etiology. Symptoms include neurologic deficits, angina pectoris, limb claudication, and abdominal pain.
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Prognosis

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  • Statistics on the natural course of cerebrovascular FMD are not available, especially because most cases are symptomatic and relatively benign.
  • Case series tend to present a relatively favorable picture of long-term stroke-free survival, both in medically and in surgically managed patients. For example, in a 1981 report, Collins et al monitored 18 patients after surgical dilatation for a mean of just over 4 years, and none had strokes. [34] They monitored 5 patients with global symptoms (eg, hypoperfusion and not embolic events) and conservative therapy for a mean of 42 months, and none had strokes.
  • Saccular aneurysm rupture has such a high mortality that autopsy series may be biased in their detection of FMD. The presence of saccular aneurysms likely poses the greatest morbidity and mortality threat, especially if blood pressure is not controlled.
  • In a prospective series of patients with carotid artery dissection observed for an average of 4 years, of those with recurrence (5 of 103), 80% had FMD. [23]
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Patient Education

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  • Patients with FMD who have experienced strokes should receive proper education in this regard. Further education regarding FMD should help patients recognize further symptoms that may indicate disease progression or complications.
  • Education regarding other risk factors for stroke should be provided where applicable. Topics should include abstinence from smoking, the benefits of a healthy diet, and good glycemic control.
  • Patients should be informed about the risk of dissection and cautioned to avoid neck trauma and rigorous neck manipulations.
  • For patient education resources, see the Brain and Nervous System, as well as Aneurysm, Brain and Stroke.
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