• Raimund Helbok, Ronny Beer, Andreas Chemelli, Florian Sohm, Gregor Broessner, Peter Lackner, Martin Sojer, Bettina Pfausler, Claudius Thomé, and Erich Schmutzhard.
• Neurological Intensive Care Unit, Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria. raimund.helbok@uki.at
• Neurocrit Care. 2011 Jun 1;14(3):433-7.

BackgroundAortic 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.MethodsThe 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.ResultsA 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.ConclusionsCerebral 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.

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