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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
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Subarachnoid haemorrhage in undiagnosed secondary hypertension: back to basics

Muhammad Ahsan Saleem1, Oliver A Leach, Thomas David Miller

  • 1Department of Neuroradiology, Western General Hospital, University of Edinburgh, Edinburgh, Midlothian, UK. dr_ahsan@yahoo.com

BMJ Case Reports
|July 18, 2012
PubMed

Insights

Undiagnosed aortic coarctation can lead to serious complications like subarachnoid hemorrhage from intracerebral aneurysms. Early diagnosis and treatment are crucial for managing secondary hypertension and preventing life-threatening events.

Area of Science:

  • Cardiology
  • Neurology
  • Radiology

Background:

  • Aortic coarctation (AC) is a congenital heart defect often diagnosed in childhood, but mild or moderate cases can remain undetected into adulthood.
  • Undiagnosed AC can lead to severe hypertension and associated complications, significantly impacting patient health.
  • Secondary hypertension in adults warrants thorough investigation for underlying causes, including congenital abnormalities.

Observation:

  • A 20-year-old woman with a history of severe hypertension presented with sudden-onset headache.
  • Cerebral CT revealed subarachnoid hemorrhage (SAH), attributed to two intracerebral aneurysms.
  • Weak femoral pulses during attempted catheterization led to the discovery of significant aortic coarctation.

Findings:

  • The patient's severe hypertension was found to be secondary to undiagnosed aortic coarctation.
  • Subarachnoid hemorrhage was caused by intracerebral aneurysms, a known complication of severe hypertension.
  • Successful endovascular coiling of the aneurysms was performed.

Implications:

  • This case highlights the importance of considering aortic coarctation in young adults with severe, unexplained hypertension.
  • Delayed diagnosis of AC can lead to life-threatening neurological complications such as aneurysmal SAH.
  • Comprehensive vascular imaging and assessment are essential in patients with secondary hypertension and neurological events.

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