Beyond iron deficiency: unmasking right-sided subclavian steal syndrome in a patient with chronic Anemia

Abstract An 83-year-old woman with chronic iron deficiency anemia presented with longstanding dizziness, brain fog, word-finding difficulty, and impaired balance despite improvement in hemoglobin levels. Examination revealed a marked inter-arm blood pressure difference greater than 100 mmHg. Computed tomography angiography demonstrated occlusion of the brachiocephalic artery and right common carotid artery, while duplex ultrasound showed retrograde flow in the right carotid and vertebral arteries, consistent with right-sided “double steal” syndrome. This rare case highlights the importance of considering vascular causes in patients with persistent neurologic symptoms and significant inter-arm blood pressure differences.