Eleven years of experience with the neurologic complications in Korean patients with acute aortic dissection: a retrospective study

BMC Neurol. 2013 May 21:13:46. doi: 10.1186/1471-2377-13-46.

Abstract

Background: This study attempts to explore the clinical features, possible mechanisms and prognosis of the neurologic complications in patients with acute aortic dissection (AD).

Methods: Medical 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.

Results: The 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.

Conclusions: The 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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm* / complications
  • Aortic Aneurysm* / epidemiology
  • Aortic Aneurysm* / mortality
  • Aortic Dissection* / complications
  • Aortic Dissection* / epidemiology
  • Aortic Dissection* / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nervous System Diseases* / epidemiology
  • Nervous System Diseases* / etiology
  • Nervous System Diseases* / mortality
  • Republic of Korea / epidemiology
  • Retrospective Studies
  • Young Adult