Ruptured cerebral aneurysm associated with coarctation of the aorta

We present a 33-year-old female who had a ruptured aneurysm at the trifurcation of the right middle cerebral artery accompanied by coarctation of the aorta. The aneurysm was successfully clipped 15 hours after the attack of subarachnoid hemorrhage and approximately 3 months later the coarctation was surgically treated. Many authors reported that the incidence of cerebral aneurysm was higher in the patients with coarctation than the general population. Our review of the literatures, however, revealed that the incidence of cerebral aneurysm was the same in the population with or without coarctation. The incidence of rupture was higher when the aneurysms was accompanied by coarctation. The average age of the patients at the aneurysmal rupture was younger in the patients with coarctation than the patients without coarctation. These findings suggested that the growth and rupture of aneurysm in the patient with coarctation are related to the hypertension and atherosclerosis. Treatment of the patients with intracranial ruptured aneurysm accompanied by coarctation should begin with the clipping of the aneurysm, and then the coarctation surgically repaired. If the aneurysm is unruptured coarctation should be repaired first, and then the aneurysm clipped.