An unusual case of malignant hypertension causing stroke in a young adult

Abstract

Middle aortic syndrome is the segmental narrowing of the abdominal aorta and its visceral branches and may be congenital or acquired. The aetiology is poorly understood but patients often present in the early decades of life with refractory hypertension secondary to renal artery involvement. An otherwise well 23-year-old male presented with a left-sided thalamic stroke secondary to severe hypertension. Imaging revealed a severely hypoplastic abdominal aorta with bilateral high grade renal orifice stenoses, including multiple right renal arteries, consistent with middle aortic syndrome. His blood pressure was aggressively managed and given improvement in his neurological signs, ongoing satisfactory blood pressure control and patient preference, he was treated conservatively with best medical therapy (multiple antihypertensive agents). This case describes a unique presentation of stroke in a young adult secondary to middle aortic syndrome, a rare cause of severe hypertension that was successfully managed conservatively through adequate blood pressure control and strict follow-up.