Subclavian steal syndrome in a patient with dizziness, left upper arm paresthesia, and exercise-related syncope-a case report

Background: Dizziness, numbness, and paresthesia of upper limbs are common symptoms in patients who undergo physiotherapy. Most of the symptoms are caused by neurological and skeletomuscular diseases. Subclavian steal syndrome is a rare case of such symptoms. Aim of the study: This study aimed to analyze how to proceed with symptomatic patients suspected of subclavian steal syndrome. Material and methods: Medical documentation was used. Case report: A 69-year-old patient, long term cigarette smoker, with the anamnesis of spine surgery due to discopathy, atherosclerosis of the lower extremities, and hypertension was referred to our hospital due to exacerbation of coronary artery disease. During his stay in the cardiac department, after smoking a cigarette, he felt pain and numbness in his left arm. He began intense movement of this hand, and then lost consciousness. A difference in pulse filling and blood pressure between the upper extremities was noted. In a duplex Doppler study, reversal flow in the left vertebral artery due to stenosis of the left subclavian artery was found. Angio-CT of the head vessels confirmed a significant stenosis of the proximal left subclavian artery. The patient was referred for further treatment to a Vascular Surgery Clinic. Conclusions: The subclavian steal syndrome is a rare cause of dizziness and paresthesia of the upper extremities. Physiotherapy procedures on the affected limb can exacerbate neurological symptoms. It is easy to identify the disease based on differences in pulse amplitude and blood pressure between upper limbs. Diagnosis should be established before proceeding with physiotherapy, due to the fact that some procedures can worsen the patient’s condition.