Article ID: 10535
We report the case of a 9-year-old boy with intracranial hemorrhage suspected to be due to renal vascular hypertension caused by fibromuscular dysplasia (FMD). The boy presented with abnormal hypertension, inarticulate speech, and right hemiparesis. The head CT revealed left putamen hemorrhage. Considering his age, we suspected vascular abnormality, such as AVM and Moyamoya disease, and performed enhanced 3D head CT. However, no vascular abnormality was confirmed. Although we performed an MRI and angiography soon after admission, we could not point out any vascular abnormality. The boy suffered from persistent severe hypertension. Although two antihypertensives, nicardipine and diltiazem, were given a full dose via continuous intravenous infusion, his blood pressure was beyond control. Follow up angiography revealed the existence of multiple intracranial microaneurysms. We suspected renal vascular hypertension and adrenal neoplasm, and performed abdominal ultrasound, abdominal MRI, renogram, and enhanced CT. We finally confirmed the existence of right renovascular stenosis by renovascular angiography, and reached to the clinical diagnosis, renovascular hypertension caused by FMD. Soon after percutaneous transluminal angioplasty (PTA) was performed, his blood pressure became under control without any medication.
