Floating-Harbor syndrome (FHS) is a rare, heritable disorder caused by variants in the SRCAP gene. Most individuals with FHS have characteristic facial features, short stature, and speech and language impairment. Although FHS has been likely under-diagnosed due to a combination of lack of recognition of the clinical phenotype and limited access to genomic testing, it is a rare condition with around 100 individuals reported in the medical literature. Case series have been biased towards younger individuals (vast majority <20 years of age) meaning that it has been challenging to provide accurate medical advice for affected individuals in adulthood.

We report two young adults with FHS who presented with intracranial haemorrhage likely secondary to cerebrovascular aneurysms, with devastating consequences, making a total of four FHS patients reported with significant cerebrovascular abnormalities. Three of four patients had hypertension, at least one in conjunction with normal renal structure. We consider possible relationships between hypertension, renal pathology and aneurysms in the context of FHS, and consider mechanisms through which disruption of the SRCAP protein may lead to vascular pathology.

We recommend that clinicians should have a low threshold to investigate symptoms suggestive of cerebrovascular disease in FHS. We advise that patients with FHS should have annual blood pressure monitoring from adolescence, renal ultrasound at diagnosis repeated in adulthood, and timely investigation of any neurological symptoms. For patients with FHS, particularly with hypertension, we advise that clinicians should consider at least one MRA (Magnetic Resonance Imaging with Angiography) to check for cerebral aneurysms.

浮港综合征（FHS）是由SRCAP基因变异引起的罕见的遗传性疾病。大多数患有FHS的人都有特征性的面部特征，身材矮小以及语音和语言障碍。尽管由于缺乏对临床表型的认识和获得基因组检测的限制，FHS可能未得到充分诊断，但在医学文献中报道的这种情况很少见，大约有100个人。病例系列偏向于年轻个体（绝大多数<20岁），这意味着为成年后的受影响个体提供准确的医疗建议具有挑战性。

我们报告了两名年轻的FHS成年人，他们可能继发于脑血管瘤继发颅内出血，并具有毁灭性后果，总共报告了四名FHS患者脑血管异常。四分之三的患者患有高血压，至少一名伴有正常的肾脏结构。我们考虑了在FHS背景下高血压，肾脏病理和动脉瘤之间的可能关系，并考虑了SRCAP蛋白破坏可能导致血管病理的机制。

我们建议临床医生应降低门槛，以调查FHS中提示脑血管疾病的症状。我们建议患有FHS的患者应从青春期开始每年进行血压监测，在成年后反复进行诊断时应进行肾脏超声检查，并及时调查任何神经系统症状。对于患有FHS（尤其是高血压）的患者，我们建议临床医生应考虑至少一项MRA（磁共振血管造影成像）检查脑动脉瘤。