Renovascular hypertension: a case with atypical neurological signs

Abstract

Secondary hypertension is the most frequent form of hypertension in children. Renovascular disease accounts for 5-10% of all childhood hypertension and should be suspected in the presence of severe hypertension found difficult to manage with medical therapy. Uncontrolled hypertension can lead to severe target organ damage. We describe the case of a 13-month-old baby boy with failure to thrive, recent muscular weakness of the lower extremities and irritability. Hypertension was detected and he was admitted to the paediatric intensive care unit with a refractory hypertensive emergency, despite multiple antihypertensive therapies. Bilateral renal artery stenosis was diagnosed through renal angiography and balloon dilation was performed, leading to lower blood pressure. He is currently withdrawing from antihypertensive medication, and slowly gaining weight and recovering from target organ damage. However, weakness of the lower extremities persists and he has been diagnosed with a neurogenic bladder.

Figure 1

Renal angiography revealing bilateral renal artery stenosis (arrows).

Figure 2

Bilateral renal artery stenosis solved after angioplasty with balloon dilation (arrow). A rupture of two collateral branches of the left renal artery occurred during the procedure, which was successfully treated by transcatheter embolisation with microcoils (arrowhead).