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.
