# Transient Ischaemic Attacks in a Girl with Subclavian Steal Syndrome

## TL;DR

A 10-year-old girl experienced transient neurological symptoms due to subclavian steal syndrome and a rare aortic configuration.

## Contribution

This case highlights subclavian steal syndrome as a rare cause of pediatric transient ischemic attacks.

## Key findings

- The girl had a right-sided aortic arch with an atypical cephalic vessel configuration.
- Reversed flow in the left vertebral artery and stenosis in the left subclavian artery were identified.
- Surgical correction was recommended for the vascular ring and subclavian artery stenosis.

## Abstract

A Transient Ischemic Attack (TIA) in children results from a temporary interruption of blood flow to the brain, leading to brief neurological symptoms. The most common causes of pediatric TIA include congenital heart defects and vascular anomalies. We present a 10-year-old girl with neurological symptoms due to subclavian steal syndrome. Physical examination revealed an asymmetry in blood pressure measurements between the upper limbs, exceeding 30 mmHg. Echocardiography revealed a right-sided aortic arch (RAA) with an atypical configuration of the cephalic vessels. Ultrasound of the vertebral arteries demonstrated reversed flow direction in the left vertebral artery. CT angiography confirmed RAA and an atypical branching pattern. The left subclavian artery was narrower with critical stenosis in its proximal segment, adjacent to the origin of the ductus arteriosus. The girl was qualified to surgical intervention to correct the incomplete vascular ring associated with a RAA and an aberrant left subclavian artery.