Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8171
Peer-review started: April 9, 2021
First decision: April 23, 2021
Revised: May 16, 2021
Accepted: August 13, 2021
Article in press: August 13, 2021
Published online: September 26, 2021
Subclavian steal syndrome (SSS) caused by Sjogren's syndrome is rare, especially for elderly patients with risk factors for atherosclerosis. The current report presents the uncommon etiology and treatment of SSS, aiming to improve doctor’s clinical experience.
A 69-year-old man was diagnosed with hypertension and acute cerebral infarction presenting with left upper limb weakness and pain even gradually aggravating to left limb hemiplegia 30 years ago. He was managed with antihypertensive and antithrombotic therapy; however, his condition was recurrent, and he never had any further examination. It was found that the difference of the bilateral upper arm systolic pressure was over 20 mmHg, and Doppler examination showed that the blood flow of the left vertebral artery was reversed, suggesting SSS. Further tests revealed a benign lymphoepithelial lesion in salivary gland tissue, confirming the Sjogren's syndrome.
The patient was found to have hypertension when he was 33 years old, and the blood pressure of both sides was asymmetric, which was ignored. The patient's symptoms of dizziness and upper limb weakness were misdiagnosed as general cerebral infarction. It is necessary to test the aorta computed tomography angiography to prove secondary hypertension factors such as Sjogren's syndrome.
Core Tip: We present a case of subclavian steal syndrome caused by Sjogren's syndrome where the patient had experienced dizziness and left upper limb weakness for 10 years despite medical treatment and was misdiagnosed as general cerebral infarction. This case illustrates the significance of detailed history collection and physical examination. A young patient with hypertension needs to measure bilateral blood pressure and examine the immunologic condition and aorta computed tomography angiography to analyze secondary hypertension factors such as Sjogren's syndrome.