A child diagnosed with midaortic syndrome and inherited thrombophilia after presenting with a stroke: A case report

Abstract

A 5-year-old female patient presented to the emergency room with right upper limb weakness, inability to speak and left side deviation of the mouth. Computed tomography (CT) scan was done and she was diagnosed with ischemic stroke. During her medical evaluation she was found to have high blood pressure (186/104 mm Hg). Investigations done to evaluate for secondary causes of hypertension and stroke revealed that she has inherited thrombophilia and abdominal aortic coarctation. Balloon angioplasty was done that lowered her elevated blood pressure, which was not responding well to antihypertensive medications, to near normal value for her age.

Keywords: Interventional cardiology; Midaortic syndrome; Pediatric stroke; Thrombophilia.

Fig. 1

A: MRI shows extensive infarction of subacute aspect (ill-defined vague hypodensity), in the territory of the left middle cerebral artery without hemorrhagic transformation and no significant mass effect. B: MRA shows the occlusion of the left middle cerebral artery.

Fig. 2

A + B Angiography revealed a smooth tapering of the infrarenal aorta down to the iliac bifurcation.

Fig. 3

A + B: Angiography showed moderate right renal artery stenosis (Arrowhead) and then it bifurcate into two arteries before reaching the hilum of the right kidney. C: Two successful TREK RX 3*25 mm balloon dilations were advanced to the appropriate place and inflated twice until the waist disappeared in right renal artery. D: Renal artery post-dilatation. The left renal artery was patent (not shown in pictures).