SUBCLAVIAN STEAL SYNDROME PRESENTING WITH INTER-ARM BLOOD PRESSURE DIFFERENCE, HEADACHE AND DIZZINESS: A DIAGNOSTIC CASE REPORT

Dr. Nimakunvarba Devda*, Dr. N. K. Gupta

ABSTRACT

Background: Subclavian artery stenosis can produce a clinically important discrepancy in blood pressure and pulse between the upper limbs. When vertebral artery flow is diverted to supply the affected arm, the resulting subclavian steal phenomenon may produce vertebrobasilar symptoms and can be overlooked when the presentation is dominated by hypertension or headache. Case presentation: A patient with a history of hypertension presented with uncontrolled blood pressure, intermittent headache and dizziness for approximately three months. A significant difference in blood pressure between the two upper limbs was documented, with associated pulse asymmetry. The patient also described right upper-limb weakness or heaviness during strenuous activity. There was no documented history of transient ischemic attack or stroke, and neurological examination did not demonstrate a focal deficit, gait abnormality or cerebellar signs. Vascular evaluation was consistent with subclavian steal physiology. The patient improved clinically after blood-pressure control. Endovascular angioplasty was advised but declined. Conclusion: A substantial inter-arm blood pressure difference should prompt careful vascular assessment rather than being attributed solely to difficult-to-control hypertension. Subclavian steal syndrome may be clinically subtle, and recognition of the pulse and blood-pressure discrepancy can provide the key bedside clue.

Keywords: Subclavian steal syndrome; subclavian artery stenosis; inter-arm blood pressure difference; vertebrobasilar insufficiency; dizziness; hypertension; vascular Doppler.