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hypertensive intracranial bleed due to mid aortic syndrome

Varadarajan Poovazhagi1, Leema Pauline, N Balakrishnan

  • 1Department of Pediatric Intensive Care, Institute of Child Health and Hospital for Children, Egmore, Chennai, Tamil Nadu, 600008, India, poomuthu@yahoo.com.

Indian Journal of Pediatrics
|September 27, 2013
PubMed

Insights

This study reports an 11-year-old experiencing intracranial bleeding from severe hypertension, diagnosed with Mid-Aortic Syndrome and suspected Takayasu arteritis. Prompt treatment led to recovery with residual hemiparesis.

Area of Science:

  • Pediatric Nephrology
  • Vascular Surgery
  • Neurology

Background:

  • Malignant hypertension in children can lead to severe neurological complications.
  • Mid-Aortic Syndrome is a rare condition characterized by aortic narrowing, often affecting renal arteries.
  • Takayasu arteritis is a large vessel vasculitis that can present with hypertension and vascular stenosis.

Observation:

  • An 11-year-old presented with severe hypertension, right hemiparesis, diminished lower limb pulses, and differential blood pressure between upper and lower limbs.
  • CT angiography identified abdominal aortic narrowing, a hypoplastic left kidney, and a thinned left renal artery, consistent with Mid-Aortic Syndrome.
  • CT brain imaging revealed a left gangliocapsular intracranial hemorrhage.

Findings:

  • The patient was diagnosed with Mid-Aortic Syndrome and intracranial bleeding secondary to malignant hypertension.
  • Treatment involved antihypertensives and steroids, addressing both the hypertension and suspected Takayasu arteritis.
  • The child showed significant clinical improvement, with residual mild hemiparesis.

Implications:

  • This case highlights the critical link between Mid-Aortic Syndrome, malignant hypertension, and intracranial hemorrhage in pediatric patients.
  • Early diagnosis and multidisciplinary management, including vascular and neurological interventions, are crucial for favorable outcomes.
  • The presentation underscores the importance of considering large vessel vasculitis like Takayasu arteritis in children with unexplained severe hypertension and vascular abnormalities.

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