Neurological Symptoms in Type A Aortic Dissections

Abstract

Background and Purpose-Aortic dissection typically presents with severe chest or back pain. Neurological symptoms may occur because of occlusion of supplying vessels or general hypotension. Especially in pain-free dissections diagnosis can be difficult and delayed. The purpose of this study is to analyze the association between type A aortic dissection and neurological symptoms. Methods-Clinical records of 102 consecutive patients with aortic dissection (63% male, median age 58 years) over 7.5 years were analyzed for medical history, preoperative clinical characteristics, treatment and outcome with main emphasis on neurological symptoms. Results-Thirty patients showed initial neurological symptoms (29%). Only two-thirds of them reported chest pain, and most patients without initial neurological symptoms experienced pain (94%). Neurological symptoms were attributable to ischemic stroke (16%), spinal cord ischemia (1%), ischemic neuropathy (11%), and hypoxic encephalopathy (2%).Other frequent symptoms were syncopes (6%) and seizures (3%). In half of the patients, neurological symptoms were transient. Postoperatively, neurological symptoms were found in 48% of all patients encompassing ischemic stroke (14%), spinal cord ischemia (4%), ischemic neuropathy (3%), hypoxic encephalopathy (8%), nerve compression (7%), and postoperative delirium (15%). Overall mortality was 23% and did not significantly differ between patients with and without initial neurological symptoms or complications. Conclusion-Aortic dissections might be missed in patients with neurological symptoms but without pain. Neurological findings in elderly hypertensive patients with asymmetrical pulses or cardiac murmur suggest dissection. Especially in patients considered for thrombolytic therapy in acute stroke further diagnostics is essential. Neurological symptoms are not necessarily associated with increased mortality. (Stroke. 2007;38:292-297.)

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

“…High-risk conditions and historical features (see Table 8). 59,[75][76][77] 72 Age >50 y 3 criteria are present (sensitivity >90%; specificity >90%) Recent-onset localized headache Temporary artery tenderness or pulse attenuation Elevated erythrocyte sedimentation >50 mm/h Arterial biopsy shows necrotizing vasculitis Behçet disease 73 Oral ulceration Oral ulceration plus 2 of the other 3 criteria Recurrent genital ulceration Uveitis or retinal vasculits Skin lesions-erythema nodosum, pseudo-folliculitis, or pathergy Ankylosing spondylitis 74 Onset of pain <40 83 …”

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

“…Gaul et al reported that chest pain was apparent in 94% of 72 AAAD patients without neurological symptoms but was only apparent in two thirds of 30 patients with symptoms. 5) Similarly in Japan, Imamura et al found that 16 of 98 patients (17%) had no pain. 6) The painless group more frequently had consciousness disturbance or other neurological symptoms and had more unfavorable outcomes.…”

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

“…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.…”