Fibromuscular Dysplasia

Fibromuscular Dysplasia (FMD) is a rare vascular condition in which abnormal cell growth occurs in the walls of medium-sized arteries, most commonly those that supply the brain (carotid and vertebral arteries) and kidneys. This can lead to narrowing, aneurysms, or dissections, increasing the risk of stroke, transient ischaemic attack (TIA), and long-term neurological complications.

At The Royal Buckinghamshire Hospital, we support adult patients who have experienced neurological events related to FMD. Our expert team offers personalised rehabilitation to help individuals recover from the functional, cognitive, or mobility challenges that may result from stroke or other FMD-related vascular injuries.

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What Is Fibromuscular Dysplasia?

FMD is a non-inflammatory and non-atherosclerotic condition. It differs from atherosclerosis in that it does not involve cholesterol deposits or typical plaque build-up, and it is not caused by infection or immune system activity.

Instead, the affected arteries develop abnormal tissue growth in the walls of the blood vessels, leading to:

• Narrowing (stenosis)
• Enlargement (aneurysm)
• Tearing (dissection)
• Reduced or unstable blood flow

FMD most commonly affects:

• Carotid arteries (neck)
• Vertebral arteries (spine to brain)
• Renal arteries (kidneys)
• Less commonly, other vessels including mesenteric and iliac arteries

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Who Is Affected?

FMD can affect people of any age but is:

• More common in women (around 90% of diagnosed cases)
• Typically diagnosed between the ages of 20 and 60
• Often underdiagnosed, especially when symptoms are mild or vague

There is no known single cause, but genetic, hormonal, and environmental factors are believed to play a role.

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Symptoms of FMD

Symptoms depend on which arteries are involved. In cases affecting the carotid or vertebral arteries, common neurological symptoms include:

• Headaches or migraines
• Dizziness or vertigo
• Neck pain
• Pulsatile tinnitus (hearing a rhythmic pulsing in the ears)
• Transient ischaemic attacks (TIAs)
• Stroke – especially in younger adults
• Visual disturbances
• Facial or limb numbness/weakness

In some patients, the first sign of FMD may be a carotid artery dissection, which can lead to an ischaemic stroke.

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Stroke Risk and FMD

FMD increases the risk of both ischaemic stroke and arterial dissection. In particular:

• Carotid or vertebral artery dissection may occur spontaneously, leading to sudden stroke-like symptoms
• FMD-related aneurysms may rupture, causing haemorrhagic stroke
• Arterial narrowing can reduce blood flow to critical areas of the brain

Stroke rehabilitation following an FMD event is often necessary to support neurological recovery, particularly in younger patients who may have no other risk factors.

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Diagnosis

FMD is diagnosed using vascular imaging:

• Duplex ultrasound
• CT angiography (CTA)
• Magnetic resonance angiography (MRA)
• Catheter-based angiogram – sometimes used for confirmation

The classic finding is a “string of beads” appearance in the artery, representing alternating narrowed and dilated sections.

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Treatment & Management

There is no cure for FMD, but treatment focuses on:

• Controlling symptoms (e.g. blood pressure, headaches)
• Preventing stroke or dissection
• Monitoring aneurysms or vascular changes
• Rehabilitation after stroke or neurological symptoms

Treatment options include:

• Antiplatelet medication (e.g. aspirin)
• Blood pressure control
• Avoiding activities that strain the neck or cause trauma
• Surgical or endovascular intervention in selected cases
• Neurological rehabilitation for motor, sensory, or cognitive impairment

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Rehabilitation at The Royal Buckinghamshire Hospital

If you have experienced a stroke, dissection, or neurological symptoms due to FMD, we provide:

• Consultant-led neurorehabilitation
• Physiotherapy to support mobility and coordination
• Occupational therapy to promote independence
• Cognitive therapy and neuropsychology
• Fatigue and lifestyle management support