DOI: 10.36347/sjmcr.2018.v06i10.002

Pages: 734-737

To report a case of a patient with brachial artery stenosis and undiagnosed severe hypertension, who developed transient ischemic attack. A 51-year-old current smoker, obese male patient was admitted to our hospital with severe dizziness, vertigo, unilateral weakness in lower limb, loss of balance, nausea and vomiting. Patient had positive family history of hypertension and stroke from paternal as well as maternal sides. Patient through years was considered as a normotensive according to the blood pressure measurements at the doctor’s office and at home. Blood pressure used to be taken on the left hand exceptionally. While checking his blood pressure after the accident, appeared a big difference between hands, namely 210/110 mmHg on the right hand and 120/80 mmHg on the left. Upper-extremity vascular stenosis is extremely uncommon pathology and brachial artery involvement is reported in about 5 to 12% of all the cases. A diameter reduction of 50% or a cross-sectional area reduction of 70%, represents a hemodynamically significant lesion, which leads to the pressure drop across the stenotic area. If blood pressure is not measured on both hands, arterial hypertension can be easily missed, like in our clinical case. In spite of in current arterial hypertension management guidelines do not indicate how often should be rechecked blood pressure simultaneously on both hands, depending on our case we can suggest, that there is a high necessity of blood pressure measurement on both arms time to time for ruling out possible stenosis of subclavian or brachial arteries and “false normotension”. We think that Arterial Hypertension Management Guidelines should recommend the time period, when it is mandatory to recheck blood pressure simultaneously on both hands.