Incidental Detection of Takayasu Arteritis Presenting as Cerebral Aneurysm with SAH: A Case Report

Keywords

Takayasu arteritis - cerebral aneurysm - SAH

Introduction: Twenty percent of Takayasu arteritis cases present with central nervous system (CNS) involvement. When CNS disease is present, it typically manifests as cerebral ischemia or stroke. There are rare reports of intracranial aneurysms in adults with Takayasu arteritis. We report the anesthetic management of a patient with Takayasu arteritis with cerebral aneurysm with subarachnoid hemorrhage (SAH) grade 1.

Methodology/Description: A 16-year-female patient weighing 42 kg posted for emergency craniotomy and clipping for ruptured left internal carotid artery (ICA) communicating segment and ICA bifurcation aneurysm with SAH grade 1. Patient presented with sudden severe headache with vomiting. Preoperatively right upper limb NIBP was persistently above 220/110 mm Hg, so lower limb NIBP reading was noted suspecting coarctation of aorta, which was significantly lower (90/60 mm Hg). On auscultation, grade 2 pansystolic murmur was heard in aortic area. Cardiology consultation was taken before proceeding for emergency clipping with the goal of maintaining cerebral hemodynamics and oxygenation, reducing ICP and maintenance of lower limb perfusion to avoid spinal cord ischemia. Intraoperatively, patient’s blood pressure was managed with vasodilators and case went uneventful. Postoperatively patient underwent CTA thorax and was diagnosed with Takayasu arteritis grade 4. Patient was discharged with Glasgow Coma Scale (GCS) of E4M6VT with right hemiplegia (MCA territory infarct).

Conclusion: Coarctation of aorta or Takayasu arteritis should be suspected in patients with multiple intracranial aneurysms. The goal of anesthesia should be focused on minimizing hemodynamic changes to prevent cerebral ischemia and adequate tissue perfusion to prevent peripheral ischemia.

• References

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