Bilateral internal carotid artery fibromuscular dysplasia identified during acute ischemic stroke evaluation: A case report

A 52-year-old woman with a known history of hypertension presented to the emergency department with acute confusion. She also had a prior history of transient ischemic attack. Computed tomography (CT) of the brain demonstrated an acute infarction involving the left insular cortex. CT angiography revealed no evidence of large-vessel occlusion; however, both cervical segments of the internal carotid arteries exhibited a tortuous course with a characteristic “string-of-beads” appearance, raising the possibility of incidental fibromuscular dysplasia (FMD). This finding was not considered the primary etiology of the acute infarction. The diagnosis of bilateral internal carotid artery fibromuscular dysplasia was subsequently confirmed by catheter angiography.