Abstract
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.
Original language | English |
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Article number | e247364 |
Journal | BMJ Case Reports |
Volume | 15 |
Issue number | 4 |
Number of pages | 4 |
ISSN | 1757-790X |
DOIs | |
Publication status | Published - 2022 |
Bibliographical note
Publisher Copyright:© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords
- Congenital disorders
- Interventional cardiology
- Neuroanaesthesia
- Radiology
- Stroke