Displasia fibro-muscular de vasos cerebrais: relato de sete casos

Antunes, Ápio Cláudio M.; Borges, Antonio Cesar G.; Costa, Jaderson Costa da; Anicet, Adão

doi:10.1590/S0004-282X1974000200005

Resumos

Os autores apresentam sete casos de displasia fibro-muscular (DFM), sendo seis deles na artéria carótida e um na artéria vertebral, estudados pelas correspondentes angiografias. São relatadas as histórias clínicas que, em cinco pacientes, são de acidente vascular cerebral isquêmico e, em dois, de hemorragia sub-aracnóide por rotura de aneurisma. Dois pacientes foram à cirurgia: um deles sofreu ligadura de carótida primitiva e outro sofreu endarterectomia para retirada de placa de ateroma da artéria carótida contralateral a aquela com DFM. Finalmente é feita breve discussão sobre a referida patologia, quadro clínico, dignóstico e tratamento, sendo ressaltada a importância do estudo angiográfico carotídeo e vertebral quando encontrada DFM em outro território vascular.

Seven cases of fibromuscular dysplasia, six of them of the carotid artery and one of the vertebral artery studied by angiography are reported. The clinical histories have been of ischemic cerebro-vascular accident in five patients and of subarachnoidal hemorrhage dependent on ruptured aneurism in the others. Two patients underwent surgery: a primitive carotid ligation in one and, in the other, an endarterectomy for ressection of an atheroma plaque of the contralateral carotid artery. The symptomatology, diagnosis and treatment are discussed, emphasizing the importance of the vertebral and carotid angiographic study in the cases in which there is a diagnosis of fibromuscular dysplasia in any other vascular territory.

Displasia fibro-muscular de vasos cerebrais. Relato de sete casos

Fibromuscular dysplasia of cerebral vessels: report of seven cases

Ápio Cláudio M. Antunes^I; Antonio Cesar G. Borges^II; Jaderson Costa da Costa^III; Adão Anicet^IV

^IServiço de Neurologia e Neurocirurgia do Hospital da Sociedade Portuguesa de Beneficência (Porto Alegre): Estagiário

^IIServiço de Neurologia e Neurocirurgia do Hospital da Sociedade Portuguesa de Beneficência (Porto Alegre): Médico-residente

^IIIServiço de Neurologia e Neurocirurgia do Hospital da Sociedade Portuguesa de Beneficência (Porto Alegre): Neurologista

^IVServiço de Neurologia e Neurocirurgia do Hospital da Sociedade Portuguesa de Beneficência (Porto Alegre): Neuro-radiologista

RESUMO

Os autores apresentam sete casos de displasia fibro-muscular (DFM), sendo seis deles na artéria carótida e um na artéria vertebral, estudados pelas correspondentes angiografias. São relatadas as histórias clínicas que, em cinco pacientes, são de acidente vascular cerebral isquêmico e, em dois, de hemorragia sub-aracnóide por rotura de aneurisma. Dois pacientes foram à cirurgia: um deles sofreu ligadura de carótida primitiva e outro sofreu endarterectomia para retirada de placa de ateroma da artéria carótida contralateral a aquela com DFM. Finalmente é feita breve discussão sobre a referida patologia, quadro clínico, dignóstico e tratamento, sendo ressaltada a importância do estudo angiográfico carotídeo e vertebral quando encontrada DFM em outro território vascular.

SUMMARY

Seven cases of fibromuscular dysplasia, six of them of the carotid artery and one of the vertebral artery studied by angiography are reported. The clinical histories have been of ischemic cerebro-vascular accident in five patients and of subarachnoidal hemorrhage dependent on ruptured aneurism in the others. Two patients underwent surgery: a primitive carotid ligation in one and, in the other, an endarterectomy for ressection of an atheroma plaque of the contralateral carotid artery. The symptomatology, diagnosis and treatment are discussed, emphasizing the importance of the vertebral and carotid angiographic study in the cases in which there is a diagnosis of fibromuscular dysplasia in any other vascular territory.

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Serviço de Neurologia e Neurocirurgia Hospital da Sociedade Portuguesa de Beneficência Av. Independência 270 90.000 Porto Alegre, RS Brasil.

1. ANDERSEN, P.E. Fibromuscular hyperplasia of the carotid arteries. Acta Radiol (Stock) 10:90, 1970.
2. ANDERSEN, P.E. Fibromuscular hyperplasia in children. Acta Radiol. (Stock.) 10:203, 1970.
3. BELBER, C.J. & HOFFMAN, R.B. The syndrome of intracranial aneurism associated with fibromuscular hyperplasia of the renal arteries. J. Neurosurg. 28:556, 1968.
4. BERGAN, J.J. & McDONALD, J.R. Recognition of cerebrovascular fibromuscular hyperplasia. Arch. Surg. 98:332, 1969.
5. CONNETT, M.C. & LANSCHE, J.M. Fibromuscular hyperplasia of the internal carotid artery; report of a case. Ann. Surg. 162:59, 1965.
6. DE BAKEY, M.E. Concepts underlying surgical treatment of cerebrovascular insufficiency. Clin. Neurosurg. 10:310, 1964.
7. EDWARDS, C.H.; GORDON, N.S. & ROB, C. The surgical treatment of internal carotid artery occlusion. Quart. J. Med. 113:67, 1960.
8. ENNIS, J.T. & BATESON, E.M. Fibromuscular dysplasia of the internal carotid arteries: report of 3 cases. Br. J. Radiol. 43:452, 1970.
9. EHRENFELD, W.K.; STONERY, R.J. & WYLIE, E.J. Fibromuscular hyperplasia of the internal carotid artery. Arch. Surg. 95:284, 1967.
10. GALLIGIONI, F.; IRACI, G. & MARIN, G. Fibromuscular hyperplasia of the extracranial internal carotid artery. J. Neurosurg. 34:647, 1971.
11. HANDA, J.; KAMIJYO, Y. & HANDA, H. Intracranial aneurism associated with fibromuscular hyperplasia of renal and internal carotid arteries. Br. J. Radiol. 43:483, 1970.
12. HARRINGTON, O.B.; CROSBY, V.G. & NICHOLAS, L. Fibromuscular hyperplasia of the internal carotid artery. Ann. Thorac. Surg. 9:516, 1970.
13. HARTMAN, J. D.; YOUNG, Y.; BANK, A.A. & ROSENBLATT, S.A. Fibromuscular hyperplasia of internal carotid arteries; stroke in a young adult complicated by oral contraceptives. Arch. Neurol. (Chicago) 25:295, 1971.
14. HOUSER, O.W. & BAKER Jr., H.L. Fibromuscular dysplasia and other uncommon diseases of the cervical carotid artery; angiographic aspects. Am J. Roentgenol. Radium Ther. Nucl. Med. 104:201, 1968.
15. HUTCHINSON, E.C. & YATES, P.O. The cervical portion of the vertebral artery; a clinico-pathological study. Brain 79:319, 1956.
16. IOSUE, A.; KIER, L. & OSTROW, D. Fibromuscular dysplasia involving the intracranial vessels; case report. J. Neurosurg. 37:49, 1972.
17. KAUFMAN, H.H. Fibromuscular hyperplasia of the carotid artery; in a case associated with an arteriovenous malformation. Arch. Neurol. (Chicago) 22:299, 1970.
18. KISHORE, P.R.S.; LIN, J.P. & KRICHEFF, I.I. Fibromuscular hyperplasia and stationary waves of the internal carotid arteries. Acta Radiol. (Stock.) 11:619, 1971.
19. LAMIS, P.A.; CARSON, W.P.; WILSON, J.P. & LETTON, A.H. Recognition and treatment of fibromuscular hyperplasia of the internal carotid artery. Surgery 69:498, 1971.
20. LEADBETTER, W.F. & BURKLAND, C.E. Hypertension in unilateral renal disease. J. Urol. 39:611, 1938.
21. LHERMITTE, F.; GAUTIER, J.C. & POIRIER, J. Hypoplasia of the internal carotid artery. Neurology (Minneapolis) 18:439, 1968.
22. McCORMACK, L.J. & DUSTAM, H.P. Pathology of renal artery disease. Postgrad. Med. 40:348, 1966.
23. MORRIS Jr., G.C.; LECHTER, A. & DE BAKEY, M.E. Surgical treatment of fibromuscular disease of the carotid arteries. Arch. Surg. 96:636, 1968.
24. PERRY, M.O. Fibromuscular disease of the carotid artery: Surg. Gynecol. Obstet. 134:57, 1972.
25. POLLOCK, M. & JACKSON, B.M. Fibromuscular dysplasia of the carotid arteries. Neurology (Minneapolis) 21:1226, 1971.
26. RAINER, W.G.; CRAMER, G.; NEWBY, J.P. & CLARKE, J.P. Fibromuscular hyperplasia of the carotid causing positional ischemia. Ann. Surg. 167:444, 1968.
27. SANDOK, B.A.; HOUSER, O.W.; BAKER Jr., H.L. & HOLLEY, K.E. Fibromuscular dysplasia; neurologic disorders associated with disease involving great vessels in the neck. Arch. Neurol. (Chicago) 24:462, 1971.
28. SMITH Jr., K.R.; NELSON, J.S. & DOOLEY, J.M. Bilateral hypoplasia of the internal carotid arteries. Neurology (Minneapolis) 18:1149, 1968.
29. THEANDER, G. Arteriography demonstration of stationary arterial waves. Acta Radiol. (Stock.) 53:417, 1960.
30. WYLIE, E.J.; BINKLEY, F.M. & PALUBINSKAS, A.J. Extrarenal fibromuscular hyperplasia. Am. J. Surg. 112:149, 1966.

Datas de Publicação

Publicação nesta coleção
16 Abr 2013
Data do Fascículo
Jun 1974

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ANDERSEN, P.E. Fibromuscular hyperplasia of the carotid arteries. Acta Radiol (Stock) 10:90, 1970.

[2] 2. ANDERSEN, P.E. Fibromuscular hyperplasia in children. Acta Radiol. (Stock.) 10:203, 1970.

[3] 3. BELBER, C.J. & HOFFMAN, R.B. The syndrome of intracranial aneurism associated with fibromuscular hyperplasia of the renal arteries. J. Neurosurg. 28:556, 1968.

[4] 4. BERGAN, J.J. & McDONALD, J.R. Recognition of cerebrovascular fibromuscular hyperplasia. Arch. Surg. 98:332, 1969.

[5] 5. CONNETT, M.C. & LANSCHE, J.M. Fibromuscular hyperplasia of the internal carotid artery; report of a case. Ann. Surg. 162:59, 1965.

[6] 6. DE BAKEY, M.E. Concepts underlying surgical treatment of cerebrovascular insufficiency. Clin. Neurosurg. 10:310, 1964.

[7] 7. EDWARDS, C.H.; GORDON, N.S. & ROB, C. The surgical treatment of internal carotid artery occlusion. Quart. J. Med. 113:67, 1960.

[8] 8. ENNIS, J.T. & BATESON, E.M. Fibromuscular dysplasia of the internal carotid arteries: report of 3 cases. Br. J. Radiol. 43:452, 1970.

[9] 9. EHRENFELD, W.K.; STONERY, R.J. & WYLIE, E.J. Fibromuscular hyperplasia of the internal carotid artery. Arch. Surg. 95:284, 1967.

[10] 10. GALLIGIONI, F.; IRACI, G. & MARIN, G. Fibromuscular hyperplasia of the extracranial internal carotid artery. J. Neurosurg. 34:647, 1971.

[11] 11. HANDA, J.; KAMIJYO, Y. & HANDA, H. Intracranial aneurism associated with fibromuscular hyperplasia of renal and internal carotid arteries. Br. J. Radiol. 43:483, 1970.

[12] 12. HARRINGTON, O.B.; CROSBY, V.G. & NICHOLAS, L. Fibromuscular hyperplasia of the internal carotid artery. Ann. Thorac. Surg. 9:516, 1970.

[13] 13. HARTMAN, J. D.; YOUNG, Y.; BANK, A.A. & ROSENBLATT, S.A. Fibromuscular hyperplasia of internal carotid arteries; stroke in a young adult complicated by oral contraceptives. Arch. Neurol. (Chicago) 25:295, 1971.

[14] 14. HOUSER, O.W. & BAKER Jr., H.L. Fibromuscular dysplasia and other uncommon diseases of the cervical carotid artery; angiographic aspects. Am J. Roentgenol. Radium Ther. Nucl. Med. 104:201, 1968.

[15] 15. HUTCHINSON, E.C. & YATES, P.O. The cervical portion of the vertebral artery; a clinico-pathological study. Brain 79:319, 1956.

[16] 16. IOSUE, A.; KIER, L. & OSTROW, D. Fibromuscular dysplasia involving the intracranial vessels; case report. J. Neurosurg. 37:49, 1972.

[17] 17. KAUFMAN, H.H. Fibromuscular hyperplasia of the carotid artery; in a case associated with an arteriovenous malformation. Arch. Neurol. (Chicago) 22:299, 1970.

[18] 18. KISHORE, P.R.S.; LIN, J.P. & KRICHEFF, I.I. Fibromuscular hyperplasia and stationary waves of the internal carotid arteries. Acta Radiol. (Stock.) 11:619, 1971.

[19] 19. LAMIS, P.A.; CARSON, W.P.; WILSON, J.P. & LETTON, A.H. Recognition and treatment of fibromuscular hyperplasia of the internal carotid artery. Surgery 69:498, 1971.

[20] 20. LEADBETTER, W.F. & BURKLAND, C.E. Hypertension in unilateral renal disease. J. Urol. 39:611, 1938.

[21] 21. LHERMITTE, F.; GAUTIER, J.C. & POIRIER, J. Hypoplasia of the internal carotid artery. Neurology (Minneapolis) 18:439, 1968.

[22] 22. McCORMACK, L.J. & DUSTAM, H.P. Pathology of renal artery disease. Postgrad. Med. 40:348, 1966.

[23] 23. MORRIS Jr., G.C.; LECHTER, A. & DE BAKEY, M.E. Surgical treatment of fibromuscular disease of the carotid arteries. Arch. Surg. 96:636, 1968.

[24] 24. PERRY, M.O. Fibromuscular disease of the carotid artery: Surg. Gynecol. Obstet. 134:57, 1972.

[25] 25. POLLOCK, M. & JACKSON, B.M. Fibromuscular dysplasia of the carotid arteries. Neurology (Minneapolis) 21:1226, 1971.

[26] 26. RAINER, W.G.; CRAMER, G.; NEWBY, J.P. & CLARKE, J.P. Fibromuscular hyperplasia of the carotid causing positional ischemia. Ann. Surg. 167:444, 1968.

[27] 27. SANDOK, B.A.; HOUSER, O.W.; BAKER Jr., H.L. & HOLLEY, K.E. Fibromuscular dysplasia; neurologic disorders associated with disease involving great vessels in the neck. Arch. Neurol. (Chicago) 24:462, 1971.

[28] 28. SMITH Jr., K.R.; NELSON, J.S. & DOOLEY, J.M. Bilateral hypoplasia of the internal carotid arteries. Neurology (Minneapolis) 18:1149, 1968.

[29] 29. THEANDER, G. Arteriography demonstration of stationary arterial waves. Acta Radiol. (Stock.) 53:417, 1960.

[30] 30. WYLIE, E.J.; BINKLEY, F.M. & PALUBINSKAS, A.J. Extrarenal fibromuscular hyperplasia. Am. J. Surg. 112:149, 1966.