Mortazavi Abolghasem, Jelodar Sina, Edraki Keyvan, Narimani Sima, Ghorbani Mohammad, Karimi-Yarandi Koroush, Asaadi Sina
Department of Neurosurgery, Sina Hospital, Tehran, Iran.
Tehran Heart Center, Department of Interventional Cardiology, Tehran University of Medical Sciences, Tehran, Iran.
Surg Neurol Int. 2020 Mar 21;11:49. doi: 10.25259/SNI_472_2019. eCollection 2020.
Electrocardiography (ECG) changes after subarachnoid hemorrhage (SAH) are well described. However, concurrent myocardial infarction (MI) and SAH are rarely reported, and its management remains a dilemma. We report a patient with traumatic SAH concurrent with acute MI that managed successfully by endovascular intervention and dual antiplatelet therapy.
A 47-year-old man was admitted to the emergency department with a complaint of severe headache. Diffuse SAH, with a Hunt and Hess score of 5, was noticed. ECG showed ST elevation in anterior leads, and cardiac troponin became positive. On brain computed tomography angiogram, a 6 mm anterior communicating artery aneurysm was seen. Considering the possibility of MI and SAH simultaneously, endovascular obliteration of the aneurysm was done, and then, the patient received dual antiplatelet medications until coronary angiography was done. Coronary angiography revealed normal epicardial coronary arteries. The patient was discharged with a Glasgow Coma Scale score of 15 and was visited 2 months after discharge without any new episodes of intracranial hemorrhage with a modified Rankin scale score of 2.
Cerebral aneurysm coiling could be considered as the first choice of treatment in the case of acute MI with hemodynamic stability, before carrying out cardiac endovascular intervention or antiplatelet medication to reduce the risk of rebleeding from a brain aneurysm.
蛛网膜下腔出血（SAH）后的心电图（ECG）变化已有详细描述。然而，并发心肌梗死（MI）和SAH的情况鲜有报道，其治疗仍存在两难困境。我们报告一例创伤性SAH并发急性MI的患者，通过血管内介入治疗和双重抗血小板治疗成功治愈。
一名47岁男性因严重头痛主诉入院急诊科。发现弥漫性SAH，Hunt和Hess分级为5级。心电图显示前壁导联ST段抬高，心肌肌钙蛋白呈阳性。脑部计算机断层血管造影显示前交通动脉有一个6mm的动脉瘤。考虑到同时存在MI和SAH的可能性，对动脉瘤进行了血管内闭塞，然后患者接受双重抗血小板药物治疗，直至进行冠状动脉造影。冠状动脉造影显示心外膜冠状动脉正常。患者出院时格拉斯哥昏迷量表评分为15分，出院后2个月随访时，改良Rankin量表评分为2分，无颅内出血新发作。
对于血流动力学稳定的急性MI合并脑动脉瘤患者，在进行心脏血管内介入治疗或抗血小板药物治疗之前，可考虑将脑动脉瘤栓塞作为首选治疗方法，以降低脑动脉瘤再出血的风险。
