Paraplegia caused by painless acute aortic dissection

Inamasu, Joji; Hori, Shingo; Yokoyama, Minato; Funabiki, Takuzo; Aoki, Katsunori; Aikawa, Naoki

doi:10.1038/sj.sc.3101087

Cited by 40 publications

(30 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The fact that patients do not define pain is a factor that makes aortic dissection diagnosis difficult and delays the treatment of the patient. The reported painless aortic dissection rate in the literature ranges between 5-15% (7,11,12,14). Recent studies revealed that indicators of the inflammatory reaction white blood cells, PLTc and D-dimer level, are closely associated with clinical outcomes in aortic events (24)(25)(26)(27)(28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

“…These cases generally apply with cardiac or neurological complaints. Congestive heart failure vena cava superior syndrome, paraplegia, syncope, repeating transient ischemic attacks, temporary loss of motor and sense in the legs along with hoarseness are among painless AAD complaints (7,(10)(11)(12)(13)(14)(15). Atypical presentations may delay the diagnosis of this disease.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Analysis of Patients Who Applied to Our Clinic with Aortic Dissection: A Five-year Experience

Burçin¹,

Karakaya²,

Yavaş³

et al. 2017

meandros

View full text Add to dashboard Cite

Objective: Although acute aort dissection (AAD) is quite difficult to be diagnosed in the emergency department, the mortality of it is very high. Therefore, the purpose of our study is to discuss the evidence of demographic characteristics, clinical, laboratory of the AAD patients who applied to emergency department over mortality. MaterialsandMethods: In our research including 73 patients with AAD diagnosed whom admitted to emergency department on January 2010-October 2015. Sex, age, presenting complaints, past medical history, arterial blood pressure, pulse, laboratory tests, transthoracic echocardiography (TTE), thoracoabdominal computerized tomography (CT), mortality and DeBakey type have been recorded on patient information form. Statistical analysis was performed in IBM SPSS Statistics Version 22.0 software package. The comparison between the two groups of data Pearson chi-square, Fisher's exact and chi-square tests were used for statistical analysis of trends. P<0.05 was considered statistically significant. Results: Fourty seven patients (64.4%) were male and 26 (35.6%) were women. In the background of the patients it was identified hypertension as the most common rate of 68.5%. The most common complaints identified were chest pain (53.4%) and back pain (42.5%). It has been determined 68 (93.1%) patients to whom CT have scanned and 27 out of 42 (64.3%) patients to whom TTE have scanned were found to have AAD. According to the DeBakey classification, 31 (42.5%) were DeBakey type 1, 18 (24.7%) DeBakey type 2 and 24 (32.9%) DeBakey type 3 as the AAD. Conclusion: Aortic dissection is still a highly mortality disease. The most important condition to reduce the mortality was thought the early diagnosis and the appropriate surgical intervention.Amaç: Akut aort diseksiyonu (AAD) acil serviste tanısı oldukça zor konulmasına rağmen mortalitesi çok yüksek bir hastalıktır. Bu nedenle, acil tıp kliniğine başvuran AAD tanılı hastaların demografik özellikleri, klinik, laboratuvar ve radyolojik bulgularının mortalite üzerine etkilerini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmamızda Ocak 2010 ile Ekim 2015 tarihleri arasında acil tıp kliniğinde AAD tanısı konulan ve çalışmaya dahil edilen 73 hasta geriye dönük incelendi. Yaş, cinsiyet, başvuru şikayetleri, özgeçmişleri, arteriyel kan basınçları, nabız sayısı, istenilen laboratuvar tetkikleri, transtorasik ekokardiyografi (TTE), kontrastlı torakoabdominal bilgisayarlı tomografi (BT) mortalite ve diseksiyon tipi

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of Patients Who Applied to Our Clinic with Aortic Dissection: A Five-year Experience

Burçin¹,

Karakaya²,

Yavaş³

et al. 2017

meandros

View full text Add to dashboard Cite

show abstract

“…In 17-40% of patients with DAs, neurologic symptoms can be manifested 6,10,11,17) . The causes of ischemic neurologic deficits are occlusions of main feeding arteries, such as the carotid, vertebral, and spinal arteries, or vasa nervorum of the peripheral nerves, or hypotension-induced perfusion failures 12) , which can induce ischemic stroke, spinal cord ischemia, ischemic neuropathy, hypoxic encephalopathy, or syncope.…”

Section: Discussionmentioning

confidence: 99%

Painless Dissecting Aneurysm of the Aorta Presenting as Simultaneous Cerebral and Spinal Cord Infarctions

Kwon

Sung

Kim

et al. 2011

J Korean Neurosurg Soc

View full text Add to dashboard Cite

and 2-8% 2) of patients with DAs, respectively. If these neurologic manifestations occur without pain, although rare, the possibility of DA can be missed without a high index of suspicion 1,7,13) . We managed a patient with a painless DA in which cerebral hemodynamic infarction and thoracic spinal cord ischemia occurred concurrently. Herein, we have focused on the important diagnostic features and therapeutic considerations of DA with a review of the literature. CASE REPORTA 51-year-old man was referred for further evaluation and treatment of paraplegia and right arm monoparesis. At the referral clinic, he was hypotensive (80/50 mmHg) and diagnosed as septic shock. In the emergency room, the blood pressure was 110/80 mmHg and the pulse was 88 beats/min. The duration of hypotension was less than 24 hours. On physical examination, there were no abnormal findings and he denied any pain in the chest, neck, back, or abdomen. On neurologic examination, the patient was somnolent, but could communicate with the examiners. There was right upper extremity weakness (motor grade II/V) and lower extremity weakness bilaterally (motor grade I/ V). Below the T6 dermatome, anesthesia to pain and hypesthesia to light touch was noted. Below the T11 dermatome, total anesthesia were demonstrated to all types of stimuli. Perianal sensation, and voluntary and involuntary anal sphincter tone could not be elicited. On a plain chest posteroanterior (PA) ra- INTRODUCTIONAn acute dissecting aneurysm (DA) of the aorta is a rare vascular event with an incidence of 5-30 cases per million people per year 12) . A DA is an uncommon, but potentially catastrophic pathologic change with an extremely high mortality and morbidity. The classic, well-known, typical symptom of DA is severe chest or abdominal pain radiating to the back. This abrupt, lancinating pain can easily make physicians alert and cautious. However, it is important that not all DAs elicit typical pain and the correct diagnosis followed by urgent management cannot always be made. In one report, a DA was missed in 38% of patients on presentation, with 28% of cases diagnosed during autopsy 16) . The frequency of pain-free DAs ranges between 5% and 15% 7,9,13,16) . Such patients with DAs demonstrate signs and symptoms dependent on the involved arterial branches from the ascending to the descending aorta.The neurologic symptoms associated with DA are often dramatic and may completely dominate the clinical features. The frequency of neurologic involvement, including transient deficits, varies between 17% and 40% 1,7,9,13) . Cerebral ischemia and Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, KoreaAuthors report a case of a painless acute dissecting aneurysm of the descending aorta in a patient who presented with unexplained hypotension followed by simultaneous paraplegia and right arm monoparesis. To our knowledge, case like this has not been reported previously. Magnetic resonance imaging of the brain and spine revealed h...

show abstract

“…2 However, painless paraplegia, as in this case, is exceedingly rare and limited to six case reports. [3][4][5][6][7][8] Paralysis in AD is due to anterior spinal artery syndrome, which usually includes loss of pain and temperature sensation, with preservation of vibration and proprioception sensation. This pattern typically manifests after spinal shock resolves over weeks.…”

mentioning

confidence: 99%

Acute Aortic Dissection Presenting as Painless Paraplegia

Rabadi

2013

J GEN INTERN MED

View full text Add to dashboard Cite

A 60-year-old man with hypertension, hyperlipidemia, and a prior abdominal aortic aneurysm repair in 1995 presented with sudden weakness of both legs. His blood pressure was 91/56 mmHg, his pulse was 107 beats/min, and he had flaccid paraplegia with a spinal sensory level at T6. Magnetic resonance imaging (MRI) of the thoracic spinal cord showed no lesion. Chest and abdominal computed tomography (CT) with contrast showed a large Type B dissecting aortic aneurysm ( Figs. 1 and 2). The following day, he developed acute renal failure requiring hemodialysis, as the dissection extended into his right renal artery. The patient was medically managed and died one week later.Acute aortic dissection (AD) usually presents in hypertensive males over the age of 60 years, as a sudden tearing chest pain radiating to the back. 1 Paraplegia due to spinal cord ischemia and infarction as a presenting manifestation of AD has been found in 1.9 % cases. 2 However, painless paraplegia, as in this case, is exceedingly rare and limited to six case reports. 3-8 Paralysis in AD is due to anterior spinal artery syndrome, which usually includes loss of pain and temperature sensation, with preservation of vibration and proprioception sensation. This pattern typically manifests after spinal shock resolves over weeks. Conflict of Interest:The author declares no conflict of interest.

show abstract

Paraplegia caused by painless acute aortic dissection

Cited by 40 publications

References 21 publications

Analysis of Patients Who Applied to Our Clinic with Aortic Dissection: A Five-year Experience

Analysis of Patients Who Applied to Our Clinic with Aortic Dissection: A Five-year Experience

Painless Dissecting Aneurysm of the Aorta Presenting as Simultaneous Cerebral and Spinal Cord Infarctions

Acute Aortic Dissection Presenting as Painless Paraplegia

Contact Info

Product

Resources

About