Abstract
Pediatric hypertension can cause hypertensive emergencies, including hemorrhagic stroke, contributing to rare but serious childhood morbidity and mortality. Renovascular hypertension (RVH) is one of the major causes of secondary hypertension in children. Grange syndrome (MIM#602531) is a rare disease characterized by multiple stenosis or occlusion of the renal, abdominal, coronary, and cerebral arteries, which can cause phenotypes of RVH and fibromuscular dysplasia (MIM#135580). We report the case of a 7-year-old girl with Grange syndrome who showed RVH and multiple seizure episodes. At 1 year of age, she experienced seizures and sequential hemiparesis caused by a left thalamic hemorrhage without cerebral vascular anomalies. Chronic hypertension was observed, and abdominal computed tomography angiography showed characteristic bilateral renal artery stenosis. Whole-exome sequencing revealed a novel homozygous pathogenic variant in the YY1AP1 gene (NM_001198903.1: c.1169del: p.Lys390Argfs*12). Biallelic YY1AP1 mutations are known to cause Grange syndrome. Unlike previously reported patients, our patient presented with intracerebral hemorrhagic stroke without anomalous brain artery or bone fragility. The phenotype in our patient may help better understand this ultra-rare syndrome. Grange syndrome should be considered in patients presenting with childhood-onset hypertension and/or hemorrhagic stroke for early clinical intervention.
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Acknowledgements
The authors appreciate the participation of all the affected individuals and their families in this study. This work was supported by AMED (grant numbers: JP18ek0109280, JP18dm0107090, JP18ek0109301, JP18ek0109348, and JP18kk020501), JSPS KAKENHI; grant numbers JP17H01539 (N. Matsumoto) and JP16K06254 (A. Takata), the Takeda Science Foundation (N. Miyake and N. Matsumoto), the Yokohama Foundation for Advancement of Medical Science, and the Hayashi Memorial Foundation for Female Natural Scientists.
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Saida, K., Kim, C.A., Ceroni, J.R.M. et al. Hemorrhagic stroke and renovascular hypertension with Grange syndrome arising from a novel pathogenic variant in YY1AP1. J Hum Genet 64, 885–890 (2019). https://doi.org/10.1038/s10038-019-0626-0
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DOI: https://doi.org/10.1038/s10038-019-0626-0
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