Z . J A M A L E D D I N E , S . E L H A D D A D , A . J . E L Q U E S S A R , N . E L A B B A D I * , R . A J A J A * * , Y. C H I K H A O U I * *

D E PA R T M E N T O F N E U R O R A D I O L O G Y, N E U R O C H I R U R G Y * , C A R D I O VA S C U L A R C H I R U R G Y * *

H O S P I TA L C H E I K H Z A I D R A B AT M O R O C C O

INTRACRANIAL ANEURYSM ASSOCIATED WITH AORTIC COARCTATION

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INTRODUCTION

The associatiation between intracranial aneurysm (AI) and aortic coarctation (CA) is rare: we report a case with a literature review .

The purpose of this work is to discuss: The clinical and radiological aspects, The pathogenesis, The management of this disorder.

OBSERVATION

A 10-year-old boy hospitalized for subarachnoid hemorrhage on the anterior communicating aneurysm.

Clinical examination: Conscious patient, No neurological deficit, Blood pressure was 160/100 mmHg.

Imaging showed aortic coarctation.

Axial computed tomography (CT) without enhancement: Subarachnoid hemorrhage of the skull base citerns ( ), the right lateral sulcus ( ).

Angio-CT reformat : Anterior communicating artery aneurysm

Angio-CT with 3D reconstruction : descending aortic coarctation

OBSERVATION

Surgical treatment was recommended at the beginning of the aneurysm and after 3 weeks for aortic coarctation,

Favorable improvement after 4 weeks were shown.

DISCUSSION

The association between AI and CA has been reported for the first time by Eppinger 1871.

The average age of discovery = 25 years old,This combination increase the risk of aneurysm

rupture. This complication can occur many years even after surgical treatment of CA.

The anterior communicating artery is the most affected (48%)

DISCUSSION

An hypothesis considering this association as a result of an embryological anomaly of the crest neurale has no real scientific foundation.

DISCUSSION

The clinical manifestations depend on: The CA site the obstruction extent.

The clinical picture may involve: The absence of one or more peripheral pulses, The blood pressure difference between upper and

lower limbs, The malignant hypertension, The development of collateral circulation sometimes

with thoracic rib notching in the chest radiography

DISCUSSION

However, the positive diagnosis of CA is often established at the stage of complications (heart failure, bacterial endocarditis, aortic dissection or cerebrovascular complications).

The selection of the indication surgery between AI and CA is controversial .

However, the AI has to be made first, given the risk of rupture in the presence of a CA.

CONCLUSION

The association AI and CA is a rare disease of adolescents and young adults.

Its pathogenesis related to abnormal embryonic neural crest has no scientific basis.

A cardiovascular examination seems necessary well-conducted systematic in any young subject carries an intracranial aneurysm.