Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

Gaul, Charly; Dietrich, W.; Erbguth, F.

doi:10.1159/000135646

Cited by 118 publications

(126 citation statements)

References 98 publications

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…2,3 Clinical manifestations of spinal cord involvement in patients with AD comprise anterior spinal cord syndrome as happened in our case, as well as transverse myelitis with complete spinal cord infarction, Brown-Sequard syndrome, progressive myelopathy or transient spinal cord ischemia. 1,2,5 The clinical profile of our patient consisted of an abrupt, painless and rapid development of anterior spinal cord syndrome. 2,5 Immediate magnetic resonance imaging findings on T1 and T2 wi concomitantly indicated dissection of the descending aorta 1,2 and early ischemic changes of the lower TH spinal cord.…”

Section: Commentmentioning

confidence: 91%

“…1 A history of hypertension is considered the most common predisposing factor of AD and is present in 62-78% of patients, 2,3 who typically present with abrupt thoracic pain. 3 The correct diagnosis is often challenging, it can be difficult and delayed especially in pain-free dissections with predominant neurological symptoms, 1,2,4 as happened in our case.…”

Section: Commentmentioning

confidence: 99%

“…6 This temporal evolution of clinical and imaging findings strongly supported a direct correlation between AD and spinal cord ischemia in accordance with recent literature data. 1,2,4 Other possible etiologies of acute myelopathy (compression, infection, inflammation) were excluded by the emergently performed laboratory examinations and finally autopsy-verified extensive AD.…”

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

Acute paraplegia in painless aortic dissection. Rich imaging with poor outcome

et al. 2009

View full text Add to dashboard Cite

Study design: Case report. Objective: To describe the clinical and imaging findings of a patient with painless aortic dissection. Setting: University Neurology Department, Thessaloniki, Greece. Patient, Methods, Results: A 46-year-old man was transferred to our Department for emergent evaluation of paraplegia, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, bilateral leg weakness, 24 h earlier. He presented complete flaccid paraplegia with urinary retention, loss of pain and temperature sensation below the TH7 level and wellpreserved vibration and position sense bilaterally. He had no pain and general physical examination was unremarkable. Chest X-rays first raised the suspicion of an aortic lesion. Thoracic MRI revealed cord dilation, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischemia. At the same MR sequences, the double lumen of the descending aorta indicated dissection in both sagittal and axial images. Later the same day, the patient died, and autopsy verified dissection of the descending aorta up to the aortic valve. Conclusion: The rapid evolution of our case further points out that radiologists, neurologists, as well as internal specialists should be vigilant for this emergency, which despite rich imaging could have a fatal outcome. Case reportA 46-year-old man was admitted to the local hospital of a nearby town, complaining for sudden, painless, bilateral leg weakness while defecating, on October 29. There was no family history of any disease and his past medical history disclosed ankylosing spondyloarthritis (positive HLA B27) diagnosed 20 years ago and hypertension treated for the last 2 years. An urgent brain and lumbar spine CT scan was unremarkable and he was transferred to our Department for further evaluation the next day.Neurologically the patient was alert, fully oriented with normal cranial nerves, upper limbs strength and reflexes. He presented complete flaccid paraplegia with urinary retention, absent plantar and deep tendon reflexes, a spinothalamic thoracic (TH) sensory level at TH7 with loss of pain and temperature sensation below this level, extending over the trunk and both lower limbs. However, he had wellpreserved vibration and position sense bilaterally. He was afebrile and complained of no pain, the electrocardiogram was normal, his arterial blood pressure was 140/80 mm Hg, heart rate 82 min À1 with sinus rhythm and no murmurs or other findings were found on general physical examination.Chest X-rays showed mediastinal enlargement first raising the suspicion of an aortic lesion. Complete blood count and routine serum biochemistry provided normal results, except for increased enzymes LDH 714 U l À1 (normal range 240-480), SGOT 95 U l À1 (range 0-38) and CPK 2866 U l À1 (range 0-190). Emergent lumbar puncture in the lateral decubitus position provided normal cerebrospinal fluid opening pressure (160 mm H 2 O) and cytochemistry (clear, no cells protein 45 mg p...

show abstract

Section: Commentmentioning

confidence: 91%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

See 1 more Smart Citation

Acute paraplegia in painless aortic dissection. Rich imaging with poor outcome

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Hypotension or neurologic conditions such as stroke, transient ischemic attack, hypoxic encephalopathy, spinal cord ischemia, and ischemic neuropathy due to dissection or occlusion of aortic branches supplying the brain, spinal cord or peripheral nerves develop in 17-29% of patients (1,3). Spinal cord ischemia is prevalent with anterior spinal artery syndrome characterized by paraplegia, areflexia, urinary retention, loss of pain, and temperature sensation, and preserved deep sensation (4).…”

mentioning

confidence: 99%

Aortic Dissection Presenting with Transient Paraplegia

Yıldız¹,

Dönmez²,

Bolayir³

et al. 2017

tnd

View full text Add to dashboard Cite

A 74-year-old man with a history of arterial hypertension presented with severe back pain and weakness in the legs. In the neurologic examination of patient, who had hypotension and bradicardia, paraparesis (1/5 muscle strength on the right and 2/5 on the left-muscle strength scale) and bilateral Babinski reflex positivity were detected; there was a loss of pain and temperature sensation below T12 level with preserved deep sensation. Contrast-enhanced spiral computed tomographic angiography revealed a minimal increase in the diameter of the ascending aorta (37 mm) and a noncalcific thrombus material surrounding the lumen of the descending aorta with a 7.5 mm size in the largest area ( Figure 1). In sagittal T2-weighted images of thoracic spinal cord magnetic resonance imaging (MRI), there was a hyperintense, "pencil-like" signal change on the anterior of the spinal cord at T8-12 levels (Figure 2A). In axial T2-weighted images, T2 hyperintense signal change patterns called "snake eyes" or "owl's eyes" were observed in the center of the spinal cord ( Figure 2B). The neurologic findings of the patient, who had been treated conservatively with a diagnosis of spinal cord ischemia secondary to type B aortic dissection, completely recovered within hours, but the patient died of sudden cardiac arrest a day after.

show abstract

“…Proksimal aortayı tutan diseksiyonlarda inme ön planda görülürken, distal aortayı tutan diseksiyonlarda spinal arterlerde ortaya çıkan dolaşım bozukluğu ile paraparezi daha sık görülür 8,9 . Serebral perfüzyon bozukluklarına bağlı olarak hastalarda senkop ve bilinç değişiklikleri gelişebilir 5,6,9,10 . Aort diseksiyonu tanı ve tedavide acil bir durumdur.…”

unclassified