Abstract
BackgroundThis study attempts to explore the clinical features, possible mechanisms and prognosis of the neurologic complications in patients with acute aortic dissection (AD).MethodsMedical records of 278 consecutive patients with AD (165 with type A and 113 with type B dissection) over 11.5 years were retrospectively analyzed for clinical history, CT findings, neurologic complications and outcome. Neurologic complications were classified into early-onset or delayed-onset complications. Independent t-test or Chi-square test (or Fisher exact test) was used for comparing the different groups. Multivariable logistic regression analysis was performed to determine the independent association between variables.ResultsThe mean age of the included patients (145 male and 133 female) was 59.4 years (range 19–91 years). 41 patients (14.7%) had a neurologic complication, which included 21 with early-onset complication and 23 with delayed-onset complication, including 3 with both. Advanced age and classic type of dissection were independently associated with the neurologic complication in patients with type A dissection. The most frequent manifestation was ischemic stroke (26 patients, 9.4%), followed by hypoxic encephalopathy (9, 3.2%), ischemic neuropathy (5, 1.8%), spinal cord ischemia (5, 1.8%), seizure (2, 0.7%), hoarseness (1, 0.4%) and septic encephalopathy (1, 0.4%). Overall in-hospital mortality was 10.1%, whereas the complicated group had a mortality rate of 43.9%. Renal impairment, pulse deficit, neurologic complication and nonsurgical treatment were independent variables for determining in-hospital mortality in patients with type A dissection.ConclusionsThe dominance of neurologic symptom in the early stage of AD may make its early diagnosis difficult. Besides chest pain and widened mediastinum in chest x-ray, variable neurologic symptoms including left hemiparesis with asymmetric pulse and hypotension may suggest underlying AD.
Highlights
This study attempts to explore the clinical features, possible mechanisms and prognosis of the neurologic complications in patients with acute aortic dissection (AD)
Pain is a typical symptom, other various symptoms can be presented by the occlusive dissection of aortic branches, aneurysmal expansion of dissected aorta or hypotension related to hemopericardium [1]
The mortality group was older (67.7 ± 12.3 versus 57.6 ± 14.1; P = 0.001), and had a higher frequency of systolic hypotension (50.0% versus 28.0%; P < 0.001), syncope (30.8% versus 10.8%; P = 0.007), azotemia (50.0% versus 7.2%; P < 0.001), mesenteric ischemia (23.1% versus 0%; P < 0.001), pulse deficit (26.9% versus 3.6%; P = 0.001), nonsurgical treatment (57.7% versus 19.4%; P < 0.001) and neurologic complication (69.2% versus 12.9%; P < 0.001)
Summary
This study attempts to explore the clinical features, possible mechanisms and prognosis of the neurologic complications in patients with acute aortic dissection (AD). Acute aortic dissection (AD) is one of the lethal cardiac diseases involving the aorta. Pain is a typical symptom, other various symptoms can be presented by the occlusive dissection of aortic branches, aneurysmal expansion of dissected aorta or hypotension related to hemopericardium [1]. Neurologic symptoms are frequent but often are dramatic and may mask the underlying disease. It is crucial to understand the neurologic symptoms related to AD. We attempt to explore the clinical features, possible mechanisms and prognosis of the neurologic complications in patients with acute aortic dissection (AD)
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