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Subarachnoid haemorrhage in a patient with undiagnosed aortic coarctation
  1. Anders Peder Højer Karlsen1,
  2. Michael Rahbek Schmidt2,
  3. Trine Stavnsgaard3 and
  4. Martin Kryspin Sørensen1
  1. 1Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark
  2. 2Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
  3. 3Department of Radiology, Rigshospitalet, Copenhagen, Denmark
  1. Correspondence to Dr Anders Peder Højer Karlsen; andersphkarlsen{at}


A man in his mid-30s was admitted with a thunderclap headache. He was conscious and hypertensive. A decade earlier, severe hypertension had been diagnosed and extensively investigated without revealing an underlying cause. Brain imaging showed subarachnoid haemorrhage caused by a ruptured pericallosal aneurysm. Endovascular occlusion was attempted, but as the sheath could not pass the aortic arch, it was converted to surgical aneurismal clipping. Intraoperative blood pressure measurement revealed a peak-to-peak gradient of 100 mm Hg across the aortic arch and an ankle/brachial index of 0.46 (normal range 0.9–1.2). Aortic coarctation was suspected, and angiographic imaging and echocardiography confirmed the diagnosis. Subacute direct stenting was performed, which normalised the peak-to-peak gradient and ankle/brachial index. To minimise the risk of severe complications, early diagnosis of aortic coarctation is important and can be facilitated by ankle/brachial index and echocardiography in the suprasternal view.

  • Neuroanaesthesia
  • Stroke
  • Congenital disorders
  • Radiology
  • Interventional cardiology

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  • Contributors AK initiated the project and drafted and critically revised the paper. TS provided pictures and critically revised the paper. MRS provided the follow-up on cardiac treatment and critically revised the paper. MKKS drafted and critically revised the paper. All authors were involved in the primary treatment of the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.