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Thalamic hemorrhage in a 4-year-old child induced by nephro-vascular hypertension
E Bianchi1, S Savasta, F Torcetta
1Pediatrics Clinic, University of Pavia, Italy.
Insights
A child developed severe hypertension and stroke due to kidney artery atrophy. Nephrectomy normalized blood pressure, resolving cardiomyopathy and neurological symptoms.
Area of Science:
- Pediatric Cardiology
- Pediatric Neurology
- Nephrology
Background:
- Cardiomyopathy in children can have diverse etiologies.
- Hypertension in pediatric patients requires thorough investigation.
- Neurological deficits like hemiparesis and dysarthria warrant urgent evaluation.
Observation:
- A 48-month-old child with pre-existing cardiomyopathy presented with acute right hemiparesis and dysarthria.
- Brain CT revealed an active hemorrhage in the left thalamus.
- Severe, treatment-resistant hypertension was noted, alongside evidence of right renal artery atrophy.
Findings:
- Elevated renin and aldosterone levels confirmed nephrogenic hypertension as the underlying cause.
- This nephrogenic hypertension was identified as the etiology for both the early-onset cardiomyopathy and the intracranial hemorrhage.
- The patient underwent right nephrectomy.
Implications:
- Nephrogenic hypertension should be considered in pediatric cases of unexplained cardiomyopathy and severe hypertension.
- Prompt diagnosis and intervention, such as nephrectomy, can effectively manage severe pediatric hypertension and its sequelae.
- This case highlights the critical link between renal vascular anomalies, hypertension, and cardiovascular and neurological complications in children.
Abstract:
A child affected by cardiomyopathy from the age of 12 months suddenly manifested right hemiparesis and dysarthria at the age of 48/12 years. Emergency brain CT showed a hemorrhage in progress in the left thalamic area. A severe form of hypertension was concomitant and resisted all pharmacological treatment. Retrograde transfemoral aortography pointed out an atrophy of the right renal artery. This finding, together with the high renin and aldosterone values, indicated a nephrogenic hypertension causing both the cardiomyopathy found at 12 months of age and the endocranial hemorrhage. Right nephrectomy led to normalization of blood pressure.