Clinical signs/symptoms of cerebrovascular fibromuscular dysplasia

Cardinal symptom or sign

Severe and/or chronic migraine headaches, especially in the presence of other suggestive symptoms or signs*

Pulsatile tinnitus ("whooshing" or "swooshing" sound in the ears timed to heart beat)

Cervical bruit on exam^¶

Stroke, TIA,^Δ or amaurosis fugax

Unilateral head/neck pain or focal neurologic findings (eg, partial Horner syndrome with ipsilateral ptosis and miosis) suggestive of a cervical artery dissection

Possible symptom

Headaches (not chronic migraine or not migraine type)

Tinnitus (not pulsatile)

Dizziness/lightheadedness

TIA: transient ischemic attack.
* Chronic migraine is defined as headache occurring on 15 or more days/month for more than 3 months, which on at least 8 days/month has the features of a migraine headache^[1].
¶ For fibromuscular dysplasia, cervical bruits are best heard high in the neck at the level of the angle of the mandible and with the bell of the stethoscope.
Δ Among patients with fibromuscular dysplasia, TIA-like events should be distinguished from migraine with aura by a dedicated neurologic assessment.

Reference:

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38:1.

From: Gornik HL, Persu A, Adlam D, et al. First international consensus on the diagnosis and management of fibromuscular dysplasia. J Hypertens 2019; 37:229. DOI: 10.1097/HJH.0000000000002019. Copyright © 2019. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.

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Clinical signs/symptoms of cerebrovascular fibromuscular dysplasia