TY - JOUR T1 - Median arcuate ligament syndrome in a patient with frontal lobe syndrome JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2020-235123 VL - 13 IS - 11 SP - e235123 AU - Sri Lakshmi Kanthan Pandian AU - Saravana Sanniyasi AU - Sanjana Ravindra AU - Narayanan D Cunnigaiper Y1 - 2020/11/01 UR - http://casereports.bmj.com/content/13/11/e235123.abstract N2 - A boy aged 19 years presented to emergency room with severe postprandial upper abdominal pain and recent significant weight loss, with history of decompressive craniotomy for post-traumatic frontal lobe haemorrhage. CT scan revealed an acute indentation of coeliac artery with high-grade stenosis and post-stenotic dilatation, diagnostic of median arcuate ligament syndrome (MALS). MALS, a diagnosis of exclusion, is identified using patient’s accurate symptomatic description. Exclusion of other causes of abdominal angina in a patient with frontal lobe syndrome was a challenging job, as they lack critical decision-making ability. Hence, the decision to proceed with the complex laparoscopic procedure was made by the patient’s parents and the surgeon, with the patient’s consent. Laparoscopic release of the median arcuate ligament resulted in relief of the patient symptoms much to the relief of his parents and the surgeon. ER -