Article Text

Download PDFPDF
Reminder of important clinical lesson
Subarachnoid haemorrhage in undiagnosed secondary hypertension: back to basics
  1. Muhammad Ahsan Saleem1,
  2. Oliver A Leach2,
  3. Thomas David Miller2,
  4. Robin J Sellar1
  1. 1Department of Neuroradiology, Western General Hospital, University of Edinburgh, Edinburgh, Midlothian, UK
  2. 2Department of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh, Midlothian, UK
  1. Correspondence to Muhammad Ahsan Saleem, dr_ahsan{at}


Aortic coarctation (AC) is a significant cause of secondary hypertension and is diagnosed in childhood in the vast majority of patients. Mild or moderate coarctation may exist undetected into adult life, when it usually presents due to its sequelae. The authors present the case of a 20-year-old woman, previously extensively investigated for severe hypertension, who was admitted following sever, sudden-onset headache. CT scanning of the head showed the presence of subarachnoid blood (SAH), with subsequent CT angiography revealing two intracerebral aneurysms as the source. On attempting to catheterise the femoral artery her pulses were noted to be weak and during passage of the catheter she was found to have significant AC. The aneurysms were duly treated with detachable coils and the clinical course with regard to the SAH was unremarkably safe for high-pressure headache.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Patient consent Obtained.