WASHINGTON – Think cerebrovascular fibromuscular dysplasia in a middle-aged woman who presents with a complaint of pulsatile tinnitus.
That’s the take-home message from a new analysis of the United States Registry for Fibromuscular Dysplasia. The data highlight pulsatile tinnitus as an important clinical manifestation of fibromuscular dysplasia (FMD). Indeed, it was a presenting symptom in one-third of 720 patients included in the national registry, Dr. Redah Z. Mahmood reported at the annual meeting of the American College of Cardiology.
FMD is a nonatherosclerotic, noninflammatory form of vascular disease. It is predominantly a disease of middle-aged women: 91% of patients in the registry were women, as were 98% of patients who presented with pulsatile tinnitus. The mean age at symptom onset for registry participants was 48.8 years, although on average another 4.2 years passed before FMD was diagnosed on the basis of angiography or noninvasive imaging, noted Dr. Mahmood of the Cleveland Clinic.
FMD presents a formidable diagnostic challenge because of its potential to appear in virtually any arterial vascular bed and its lack of specific symptoms. The FMD registry was formed in 2008 in an effort to shed new light on the disorder. The association with pulsatile tinnitus is particularly helpful in raising the index of suspicion, he continued.
Patients with pulsatile tinnitus as a presenting symptom of FMD were more likely than those without that complaint to have frequent headaches, by a margin of 71%-47%. Nearly half of FMD patients with pulsatile tinnitus reported neck pain, compared with 19% without pulsatile tinnitus. Dizziness, transient ischemic attacks, cervical bruit, and Horner syndrome also were significantly more common in the pulsatile tinnitus group. This cluster of symptoms reflects the pulsatile tinnitus group’s increased prevalence of FMD of the medial fibroplasia type involving the extracranial carotid and vertebral artery beds. Patients with pulsatile tinnitus were not more likely, however, to present with stroke, which was a presenting symptom in only about 8% of patients.
Patients with pulsatile tinnitus had a reduced likelihood of renal and mesenteric involvement. Fifty-three percent of them had hypertension, compared with 67% of FMD patients without pulsatile tinnitus.
Thirty-two percent of FMD patients with pulsatile tinnitus had a history of an anxiety disorder, a rate twice that of patients without pulsatile tinnitus. Intriguingly, 84% of patients with pulsatile tinnitus had a history of use of oral contraceptives or hormone replacement therapy, compared with 56% of those without pulsatile tinnitus.
This study was sponsored by the Fibromuscular Dysplasia Study of America, a nonprofit organization. Dr. Mahmood reported having no financial conflicts.