Intracranial aneurysms associated with unsuspected aortic coarctation

Abstract

Intracranial aneurysms (IAs) are found more often in patients with aortic coarctation (AC) than in the general population and aneurysm rupture occurs much earlier in the lives of these patients when there is coexistent AC. The diagnosis of AC is frequently made only after a serious cerebrovascular complication has developed. The aim of this paper is to call attention to AC in patients presenting with aneurysmal subarachnoid hemorrhage. The literature is reviewed, the key clinical features are highlighted, and the proposed pathogenesis of this association is discussed. The authors present clinical information and imaging data obtained in three young patients with ruptured IAs that were associated with initially unnoticed AC. Abnormal results of cardiovascular examinations led the authors to consider an underlying AC, which was later confirmed by aortography. These aneurysms were successfully treated prior to correction of the ACs. The diagnosis of AC should be considered in adolescent and young adult patients presenting with IAs.

Results of Screening for Intracranial Aneurysms in Patients with Coarctation of the Aorta

“…There is, however, some evidence that rupture of IAs may occur earlier in patients with coarctation of the aorta than in the general population 21,30 and that treating hypertension may also reduce the risk of aneurysm rupture when an aneurysm is present. Identification of an IA may urge us to treat a patient's blood pressure aggressively and to caution them strongly against other risk factors for the development of IAs, such as smoking.…”

“…10,21 In our study, the median age of patients with IAs was only 29 years (range, 16 -59 years). Patients with IAs were, on average, 14 years older than those without, and the size of the aneurysm was significantly correlated with age.…”

“…10 Most interesting, none of our patients had multiple aneurysms, in contrast to previous studies in which these have occurred in Յ14% of patients. 10,21 This may be due to the young age of the patients.…”

Subarachnoid Aneurysmal Hemorrhage Associated with Coarctation of the Aorta: Case Report and Review of the Literature

“…25,26 . This In CoA patients, narrowing of the aortic lumen usually occurs distal to the origin of the left subclavian artery, leading to upper extremity and intracranial hypertension 12 . Hypertension is the main risk factor for the formation of single IAs 33 35 , multiple IAs 36 38 , and their rupture 39 42 .…”

Multimodal Neuromonitoring in a Patient with Aneurysmal Subarachnoid Hemorrhage Associated with Aortic Coarctation

“…With an 4.8% incidence of aneurysm rupture as a cause of death, spontaneous SAH is far more common when compared to the general population [4]. Narrowing of the lumen of the aorta usually occurs distal to the origin of the left subcalvian artery leading to a high arterial pressure state in the arteries prior to that [5]. The main pathophysiologic mechanism leading to intracranial aneurysms in AC is arterial hypertension [2]; however, a developmental disorder of the neuronal chest has also been postulated [6].…”