Ischemic stroke as the initial presentation of undiagnosed aortic coarctation in an adolescent: a case report

Coarctation of the aorta is a congenital cardiovascular anomaly that may remain undiagnosed until adolescence. Delayed diagnosis can result in serious complications, including systemic hypertension and cerebrovascular events. We report the case of a 16-year-old Ethiopian boy who presented with sudden-onset right-sided hemiparesis and expressive aphasia. Examination revealed a marked discrepancy between the upper and lower limb blood pressures and absent femoral pulses. Neuroimaging revealed a large left middle cerebral artery infarction. Transthoracic echocardiography and computed tomography angiography confirmed severe native coarctation of the aorta distal to the left subclavian artery, associated with a bicuspid aortic valve and extensive collateral circulation. The patient was treated for ischemic stroke and hypertensive urgency and was referred for definitive surgical correction. Ischemic stroke may be a rare initial manifestation of undiagnosed aortic coarctation in adolescents. Routine four-limb blood pressure measurements are essential for the early diagnosis and prevention of catastrophic outcomes.