Transient Ischaemic Attacks in a Girl with Subclavian Steal Syndrome

Area of Science:

• Pediatric Neurology
• Vascular Surgery
• Cardiology

Background:

• Transient Ischemic Attack (TIA) in children is a critical neurological event caused by temporary brain blood flow interruption.
• Congenital heart defects and vascular anomalies are common etiologies for pediatric TIA.
• Subclavian steal syndrome is a rare cause of TIA, particularly in pediatric cases.

Purpose of the Study:

• To present a rare case of pediatric TIA secondary to subclavian steal syndrome.
• To illustrate the diagnostic process and imaging findings in a child with this condition.
• To discuss the surgical management of an incomplete vascular ring associated with a right-sided aortic arch (RAA) and aberrant left subclavian artery.

Main Methods:

• Clinical presentation of a 10-year-old girl with neurological symptoms.
• Physical examination noting significant blood pressure asymmetry between upper limbs (>30 mmHg).
• Diagnostic imaging including echocardiography, vertebral artery ultrasound, and CT angiography.

Main Results:

• Echocardiography revealed a right-sided aortic arch (RAA) with atypical cephalic vessel configuration.
• Vertebral artery ultrasound showed reversed flow in the left vertebral artery, indicative of steal.
• CT angiography confirmed RAA, aberrant branching, and critical stenosis of the proximal left subclavian artery.

Conclusions:

• Subclavian steal syndrome, secondary to RAA and aberrant left subclavian artery, can cause TIA in children.
• Multimodal imaging is crucial for diagnosing complex pediatric vascular anomalies.
• Surgical intervention is indicated for symptomatic cases to correct the underlying vascular defect.