Question

A ten year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity is measured as 200/140 mm Hg. Femoral pulses are not palpable. The most likely diagnosis amongst the following is:

• A. Takayasu aortoarteritis
• B. Renal parenchymal disease
• C. Grand mal seizures
• D. Coarctation of aorta

Hint:

High arm BP plus absent femoral pulses equals a narrowed aorta.

Answer 1

The Correct Option is D

Two findings carry this case: severe hypertension recorded in the arm and femoral pulses you cannot feel. When the pressure is high above and the pulses vanish below, the aorta is narrowed somewhere between the two.

The classic congenital lesion that does this is coarctation of the aorta. The constriction lies just distal to the left subclavian artery, so the upper body runs hypertensive while the legs are underperfused, giving weak or absent femoral pulses and a radio-femoral delay. The malignant pressure of 200/140 can readily provoke a seizure, explaining the presentation.

Sort the others out. Takayasu disease can also cause a pulseless state, but it favors young adult women and a broad set of vessels, and it is not the textbook child answer here. Renal parenchymal disease raises blood pressure yet leaves femoral pulses intact. A grand mal seizure is merely the event itself and explains neither the pulse deficit nor the arm-to-leg pressure gap.

The unifying diagnosis is coarctation of the aorta.
\[\boxed{\text{Coarctation of aorta}}\]