Introduction: Patients with complex congenital heart disease may develop complications anytime during the course of their illness. A rare neurologic complication in children is cerebral aneurysm. Intracranial aneurysm treatment is not as well standardized as in adults. Consequently, the management of these potentially lethal lesions can pose problems for patients and their physicians.
Objectives: To present a rare case of a complex congenital heart disease (DORV, PDA, COA, severe PAH) with multiple cerebral aneurysms. Specifically to present the clinical manifestations, the approach to the diagnosis, the pathophysiology, the management options and the prognosis among these patients.
Case Description: A 13 year old female had cyanosis during infancy. She had recurrent cough, interrupted feeding and failure to thrive. Examination revealed a cyanotic patient, with a murmur and a significantly higher blood pressure on the upper extremities. Work ups confirmed a finding of complex congenital heart disease. At 13 years of age, she suddenly felt severe frontal headache. CTS showed ruptured cerebral aneurysm and angiogram revealed multiple unruptured cerebral aneurysms.
Conclusion: Coarctation of the aorta with multiple cerebral aneurysms carry a very high risk for mortality and that there has been no guidelines as to the timing of the surgical treatment when presented with the two conditions at the same time. The complexity of the patients neurologic and cardiac problem poses more harm than benefit when surgically corrected hence no surgical intervention is contemplated.
Recommendation: Since patients with COA are at increased risk of developing cerebral aneurysm, it could be an advantage if we do routine neurologic work up among these patients even before symptoms set in, that way, earlier intervention could be done to pevent worst possible complications that may arise during the course of the illness.