The hidden culprit: late discovery of coarctation of aorta after stroke

Background. Coarctation of the aorta (CoA) is a congenital narrowing of the thoracic aorta, usually diagnosed in childhood. Delayed recognition in adults can result in life-threatening complications. Case presentation. We report the case of a 55-year-old man who presented with acute intracerebral hemorrhage in the setting of severe hypertension. Further evaluation revealed postductal CoA with extensive collateral circulation and aneurysmal dilatation. Despite intensive supportive care, the patient deteriorated and died from multi-organ complications. Discussion. This case underscores the importance of bedside examination, including four-limb blood pressure measurement and femoral pulse assessment, in hypertensive patients. Advanced imaging such as CT angiography remains essential for diagnosis and treatment planning. Surgical or endovascular repair constitutes definitive management, although late complications may persist. Conclusion. Adult-presenting CoA is uncommon but clinically significant. Awareness of secondary hypertension and consideration of late-presenting congenital heart disease are crucial for improving outcomes.