Anaesthetic management of intracranial aneurysm in patient with coarctation of aorta

Introduction: Intracranial aneurysms are more often found in patients with coarctation of aorta (COA) than in general population. Aneurysm rupture occurs much earlier in these patients. Here, two cases of ruptured cerebral aneurysms associated with COA are presented. The aneurysms were successfully clipped in acute stage prior to correction of coarctation. Patients with COA should have screening for early diagnosis of cerebral aneurysms. Ruptured aneurysm should be treated as early as possible. Unruptured aneurysm should also be treated before aortic repair, if general condition of patient allows. Case Summary: Case 1: 14 year old boy presented with sudden onset headache followed by loss of consciousness. BP was 210/100 mm of Hg, very feeble femoral pulses. Contrast CT scan brain revealed ruptured distal anterior communicating artery aneurysm. Aortogram revealed total obstruction in descending thoracic aorta distal to origin of left subclavian artery. Clipping of aneurysm was planned first, followed by COA repair. Patient was discharged after complete recovery. Case 2: 15 year old boy presented with sudden onset headache, vomiting, one GTCS episode. BP was 180/130 mm of Hg. Cerebral CT angiography revealed saccular aneurysm from anterior communicating artery. CT aortogram reported preductal COA. Clipping of aneurysm was performed successfully. Conclusion: Early diagnosis and repair of COA prevents cerebrovascular complications; although aneurysm can occur even after COA repair. Recent advances in anaesthesiaand neurosurgical techniques allow surgery of ruptured cerebral aneurysm in presence of untreated coarctation with relative safety.

No conflict of interest has been declared by the author(s).