To illustrate the imaging features of fibromuscular dysplasia (FMD) in this rare presumptive case of FMD in a sixteen year old male with intracranial features only and highlight it as an important cause of stroke in the young. FMD is a non-atheroscelerotic, non-inflammatory vasculopathic arterial disease affecting large and medium size vessels of unknown aetiology. It is a rare cause of paediatric stroke and strokes in young adults. This is a pictorial presentation of an unusual presumptive case of fibromuscular dysplasia (FMD) affecting the middle cerebral artery in a sixteen year old male with classic Digital Subtraction Angiography (DSA) findings. The focal neurological findings and pattern seen on sequential brain scans clearly associates the presence of this vascular lesion to cerebral infarction. Classic imaging findings of the epidemiology, pathology and radiological appearance of FMD are discussed. Emphasis is placed on the patient's imaging presentations including DSA. FMD is a vascular dysplasia that typical affects the renal vasculature and commonly the extracranial internal carotid artery. When a young adult or child presents with stroke FMD should be considered and is more likely to have intracranial features.