Ruptured intracranial aneurysm associated with coarctation of the aorta: Report of a patient treated by hypothermia and surgical repair of the coarctation ∗

Abstract

A case is reported of a fourteen year old boy with coarctation of the aorta who suffered rupture of an intracranial ancurysni. The patient was treated by antihypertensive drugs, a period of controlled hypothermia and surgical correction of the coarctation during the period of active intracranial bleeding. To our knowlledge this is the first case of this condition in which successful repair of the coarctation has been accomplished during the period of acute intracranial bleeding. Thirty-two additional cases of intracranial aneurysm associated with coarctation have been reviewed. Rupture of the aneurysms occurred at an earlier age and was associated with a greater mortality rate than in aneurysms unassociated with coarctation. Hypothermia, by reducing the arterial pressure and diminishing cerebral edema and anoxia, appears to be beneficial to these patients. Both carotid and vertebral arteriography should be performed because of the high incidence of multiple ancurysms. The question is discussed as to whether the coarctation should be repaired before the ruptured aneurysm or whether the aneurysm should be corrected first with subsequent repair of the coarctation. It is our belief that the latter is preferable. It must be emphasized that the time interval between the repair of both lesions should be extremely limited.