821 - Ischemic Stroke Secondary to Fibromuscular Dysplasia in a 15-Year-Old Male

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

VM

Vanessa D. Molina, BS

Medical Student - OMS 4
Sam Houston State University College of Osteopathic Medicine
Houston, Texas, United States

Co-Author(s)

LL

Lilly Lerer, MD

Resident Physician
Northwestern University
Chciago, Illinois, United States
SS

Stacy M. Stibb, DO

Attending Physician/Associate Professor
Shirley Ryan Abilitylab/Northwestern Feinberg School of Medicine
Chicago, Illinois, United States

Submitter(s)

VM

Vanessa D. Molina, DO

Sam Houston State University College of Osteopathic Medicine
Houston, Texas, United States

Case Diagnosis: Right Middle Cerebral Artery (MCA) ischemic stroke secondary to focal Fibromuscular Dysplasia (FMD)

Case Description: 15-year-old male with no past medical history presented to the emergency department with left facial droop, left sided weakness, and headache. Head CT revealed stenosis of the right MCA and the patient was diagnosed with a right MCA ischemic stroke. Further imaging revealed stenosis of the right internal carotid artery, right renal artery, celiac artery, and superior mesenteric artery. Etiology confirmed as fibromuscular dysplasia. The patient underwent thrombectomy with four passes and stenting twice after recurrent occlusion. He was started on dual anti-platelet therapy (DAPT) and discharged to acute inpatient rehabilitation.

Admission exam noted deficits in balance, coordination, endurance, left hemibody weakness, and persistent headache. 

Precautions were set by neurosurgery of no high-intensity cardiovascular exercise, no lifting greater than ten pounds, and no activities with risk of falling.

The patient progressed well and on discharge demonstrated improved left hemibody strength and no report of headache for several days.

Discussions: Fibromuscular dysplasia is a rare, idiopathic nonatherosclerotic arteriopathy which typically presents in early adulthood and more commonly affects females. Cerebrovascular FMD occurs at similar rates to renovascular FMD. FMD may appear either focally or multi-focally, appearing as either stenosis or “beads on a string” on angiographic imaging. Those who present with stroke require unique rehabilitation care, as precautions while on DAPT pose an obstacle to optimal rehabilitation which includes high-intensity exercise and strength training.

Conclusions: Patients with stroke secondary to FMD can improve function in the acute inpatient rehabilitation setting. However, understanding bleeding risk while on DAPT and possibility for recurrent occlusion are pertinent to fostering a safe rehabilitation course.