Intermittent claudication of one cerebral hemisphere

Area of Science:

• Neurology
• Vascular Neurology
• Pediatric Neurology

Background:

• Hyperventilation can trigger neurological symptoms in susceptible individuals.
• The differential diagnosis for transient neurological deficits is broad.
• Vascular anomalies can present with diverse clinical manifestations.

Observation:

• A 13-year-old female presented with recurrent unilateral sensory and motor symptoms exclusively during hyperventilation.
• Initial presentation suggested a diagnosis of hysteria due to the episodic nature and trigger.
• Clinical examination revealed transient neurological deficits consistent with focal cerebral ischemia.

Findings:

• Vascular investigation revealed hypoplasia of the left internal carotid artery and a portion of the circle of Willis.
• This anatomical abnormality compromised cerebral blood flow to the left hemisphere.
• Hypocapnia induced by hyperventilation exacerbated the compromised blood flow, precipitating ischemic symptoms.

Implications:

• This case highlights the importance of considering vascular causes in young patients with unexplained neurological symptoms.
• It underscores the role of hypocapnia-induced cerebral hypoperfusion in unmasking underlying vascular abnormalities.
• The findings suggest that congenital vascular anomalies, even subtle ones, can manifest as functional neurological symptoms in adolescents.