Neurological Manifestations of Aortic Dissection: A Scoping Review.

Abstract

Aortic dissection (AD) is the most prevalent aortic pathology, with an incidence of 2.6-3.5 cases per 100,000 inhabitants per year with mortality rates as high as 90% at 3 months without proper management. Despite the presence of typical symptoms, it has been reported that up to 38% of cases go unnoticed in the initial evaluation, either due to additional symptomatology or the absence of classic symptoms. In 28% of cases the diagnosis is made post-mortem, highlighting the severity and importance of timely diagnosis. The main goals of this study were to identify the primary neurological manifestations of acute AD and the frequency of these manifestations in type A and B AD according to the Stanford classification. A total of 2,734 records were retrieved from two databases, of which 2,611 were excluded. Therefore, 123 articles were obtained and 88 were evaluated for eligibility. Consequently, 79 articles were included in the review. The abstracts identified in the search were screened by seven blinded independent authors and excluded those who lacked relevance. The authors read the full texts independently to determine inclusion. A third reviewer adjudicated discrepancies when opinions were at odds. There were 169 patients diagnosed with Stanford type A, of which 43.8% displayed quantitative impairment of consciousness. Within this group, transient loss of consciousness was observed in 34.3% of cases. Motor syndrome was present in 54.5%, with 23.7% of patients presenting with hemiparesis or hemiplegia. 3.6% had facial paresis or paralysis and less frequently monoparesis, paraparesis, hyperreflexia, spasticity, and muscle spasms. 7.6% presented with language impairments including Broca's aphasia and dysarthria. Seizures were present in 3.6%. Neuro-ophthalmological symptoms were 2.9%, cortical or cognitive symptoms and headache were 2.3%, cerebellar syndrome was 1.8%, and sensory syndrome was 1.2%. Of 86 patients diagnosed with Stanford type B, 57.0% displayed motor syndrome, with 50.0% being paraparesis or paraplegia, 4.7% monoplegia, and 2.3% hemiplegia or hemiparesis. Additionally, impairment of consciousness was present in 26.7%, sensory syndrome in 12.8%, and language impairments in 3.5%. In the emergency department, understanding the neurological manifestations in both Stanford type A and B dissections emerges as a pivotal cornerstone for conducting precise assessments and efficient patient management. Given the wide spectrum of manifestations, we emphasize the importance of suspecting AD when neurological disorders are associated with the classic symptoms. In these cases, we encourage a complete neurological examination to be performed and a multidisciplinary group assembled to tackle this entity.