RT Journal Article
SR Electronic
T1 Subarachnoid haemorrhage in a patient with undiagnosed aortic coarctation
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e247364
DO 10.1136/bcr-2021-247364
VO 15
IS 4
A1 Anders Peder Højer Karlsen
A1 Michael Rahbek Schmidt
A1 Trine Stavnsgaard
A1 Martin Kryspin Sørensen
YR 2022
UL http://casereports.bmj.com/content/15/4/e247364.abstract
AB 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.