Coarctation of the aorta and subarachnoid hemorrhage from an anterior communicating artery aneurysm in an 11-year-old: illustrative case

BACKGROUND: The authors report the case of an 11-year-old boy who presented with sudden-onset severe headache owing to a subarachnoid hemorrhage (SAH) due to rupture of an anterior communicating artery aneurysm. OBSERVATIONS: Clinical examination revealed a discrepancy in blood pressure between the upper and lower extremities, prompting further cardiovascular evaluation. Imaging identified a previously undetected coarctation of the distal aortic arch (CoA). The patient had been considered healthy and asymptomatic prior to presentation. LESSONS: The coexistence of CoA and an intracranial aneurysm (IA) is rare in pediatric patients and poses significant management challenges. Treatment involved surgical clipping of the ruptured IA, followed by repair of the CoA in a staged approach. This highlights the importance of prioritizing cerebrovascular risk while planning for cardiovascular correction. This case emphasizes the need for early, comprehensive cardiovascular and cerebrovascular assessment in children presenting with SAH. Multidisciplinary collaboration is essential to address both acute and long-term risks, including recurrence of IA or complications related to CoA. Blood pressure monitoring and long-term follow-up with cerebrovascular imaging are critical. Reporting such cases is vital for understanding the association between CoA and IA and in refining diagnostic and therapeutic strategies for this uncommon but clinically significant scenario. https://thejns.org/doi/10.3171/CASE25991.