Subarachnoid haemorrhage in a patient with undiagnosed aortic coarctation.
Anders Peder Højer KarlsenMichael Rahbek SchmidtTrine StavnsgaardMartin Kryspin SørensenPublished in: BMJ case reports (2022)
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.
Keyphrases
- blood pressure
- left ventricular
- aortic valve
- aortic dissection
- pulmonary artery
- high resolution
- pulmonary hypertension
- arterial hypertension
- coronary artery
- hypertensive patients
- computed tomography
- peripheral artery disease
- heart rate
- heart failure
- case report
- patients undergoing
- single cell
- white matter
- multidrug resistant
- pulmonary arterial hypertension
- multiple sclerosis
- risk factors
- fluorescence imaging
- metabolic syndrome
- atomic force microscopy
- coronary artery disease
- mass spectrometry
- adipose tissue
- photodynamic therapy