Article
Subarachnoid hemorrhage in association with aortic coarctation – a case report
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Published: | June 8, 2016 |
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Objective: Coarctation of aorta (CoA) is a connective tissue disorder. The most concomitant non cardiac abnormality and serious consequence are multiple intracranial aneurysms (IAs). The incidence of CoA in patients with IAs is low and estimated to be at 0.19% to 1.9% and mean at 0.45%, whereas the association of multiple IAs with CoA has been reported starting from 2.5% to as high as 50%. Moreover the incidence of a subarachnoidal hemorrhage (SAH) in patients with CoA is higher (4.8%) than estimated rate of aneurysmal rupture in general population (less than 1%). We present a case of a ruptured cerebral aneurysm with undiagnosed CoA and additional innocent IAs, concerning clinical and radiological features and outcome after treatment.
Method: Through a retrospective review a case of multiple IAs in association with CoA was compared with current literature. For a detailed follow-up we carried out a correspondence with the University of Cologne, department of pediatric cardiology, where the patient has been treated cardiological after sufficient recovery.
Results: We present a case of a 27-year-old man with SAH, based on a ruptured aneurysm of the anterior communicating artery (ACoA) and multiple innocent IAs and so far unknown CoA. CTA confirms the CoA 2cm distal to the origin of the left subclavian artery and 2,6mm in diameter. Treatment was to clip the ruptured aneurysm of the ACoA and the two aneurysms located at the medial cerebral artery (MCA) on the left side. Secondly the non-ruptured aneurysm of the right MCA was coiled. A 1mm-sized right aneurysm of the MCA was not treated. The interdisciplinary treatment and monitoring was the most demanding by controlling blood pressure after SAH and insuring sufficient end-organ perfusion. After rehabilitation the CoA was treated in university hospital for pediatric cardiology. With a self covered stent the stenosis was successfully widened. Currently the patient is good recovering and despite a mild hemiparesis in employment.
Conclusions: Treatment of SAH demands an advanced monitoring especially of blood pressure during critical course of vasospasm. The goal of this report is to call attention to the combination of CoA and multiple IAs and to illustrate the importance of multidisciplinary approach.