Multimodal neuromonitoring in a patient with aneurysmal subarachnoid hemorrhage associated with aortic coarctation.
BACKGROUND
Aortic coarctation (AC) rarely remains undiagnosed until adulthood. Intracranial aneurysms and spontaneous subarachnoid hemorrhage (SAH) are more frequent in patients with AC than in the general population.


METHODS
The purpose of this report is to describe the management of a poor grade SAH patient with previously undiagnosed AC using advanced monitoring techniques of the brain and the cardiovascular system.


RESULTS
A 28-year-old man with previously unknown AC was admitted with aneurysmal SAH WFNS grade 5. Head computed tomography demonstrated thick blood filling the basal cisterns, mild hydrocephalus, and global cerebral edema. The ruptured aneurysm of the anterior communicating artery was successfully coiled on the same day. Echocardiography revealed high grade isthmus stenosis with a pressure gradient of 60 mm Hg. Hospital course was complicated by prerenal failure and severe vasospasm. Neuromonitoring data (cerebral metabolism, brain tissue oxygenation, cerebral blood flow and intracranial pressure) were used as endpoint to define the optimal blood pressure to meet the cerebral metabolic and oxygen demand in each phase.


CONCLUSIONS
Cerebral aneurysm rupture associated with coarctation of the aorta is rare. The aim of this report is to call attention to AC in, particularly, young patients presenting with SAH and to discuss advanced multimodal neuromonitoring techniques used to optimize intensive care management.
Neurological Intensive Care Unit, Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria. raimund.helbok@uki.at
Raimund
R
Helbok
Ronny
R
Beer
Andreas
A
Chemelli
Florian
F
Sohm
Gregor
G
Broessner
Peter
P
Lackner
Martin
M
Sojer
Bettina
B
Pfausler
Claudius
C
Thomé
Erich
E
Schmutzhard
D000328:Adult; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000503:physiopathology; D001017:Aortic Coarctation / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D001027:Aortography; D001921:Brain / Q000503:physiopathology; D003422:Critical Care / Q000379:methods*; D003937:Diagnosis, Differential; D004734:Energy Metabolism / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000503:physiopathology*; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D017551:Microdialysis; D008991:Monitoring, Physiologic / Q000379:methods*; D010101:Oxygen Consumption / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000503:physiopathology
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