Aggravating headache accompanied by nausea and epigastric discomfort suggesting a warning leak in a 39-year-old woman with a giant thrombosed intracranial aneurysm prompted us to undertake coiling of the aneurysm. After uneventful coil embolization of the aneurysm, collapse of the lung related to bronchospam developed, and was found to have a gastrointestinal pathology which had gone undetected before the procedure. Despite its rarity, gastrointestinal pathology mimicking warning leak should have been considered in a patient with a warning leak sign.
LeblancR: The minor leak preceding subarachnoid hemorrhage. J Neurosurg66: 35–39, 1987.
2.
ZikkDRapoportY: Acute airway obstruction and achalasia of the esophagus. Ann Otol Rhinol Laryngol98: 641–643, 1989.
3.
WagaSOtsuboK: Warning signs in intracranial aneurysms. Surg Neurol3: 15–20, 1975.
4.
TornerJCKassellNF: Preoperative prognostic factors for rebleeding and survival in aneurysm patients receiving antifibrinolytic therapy: Report of the cooperative aneurysm study. Neurosurgery9: 506–513, 1981.
5.
WiebersDO: Unruptured intracranial aneurysms: Natural history and clinical management. Update on the international study of unruptured intracranial aneurysms. Neuroimaging Clin N Am16: 383–390, vii, 2006.
6.
WiebersDOWhisnantJP: Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet362: 103–110, 2003.
7.
OstergaardJR: Warning leak in subarachnoid haemorrhage. BMJ301: 190–191, 1990.
8.
VantrappenGJanssensJ: Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology76: 450–457, 1979.
9.
AggestrupSUddmanR: Lack of vasoactive intestinal polypeptide nerves in esophageal achalasia. Gastroenterology84: 924–927, 1983.
10.
TottrupASvaneD: Nitric oxide mediating nanc inhibition in opossum lower esophageal sphincter. Am J Physiol260: 385–389, 1991.