[Neurologic complications of aortic dissection].
BACKGROUND
Beside the damages of the cardiovascular system the lesions of the the nervous system are the most common complications of aortic dissection. This is usually an early event, therefore the dissection of the aorta may manifest itself as an acute primary neurologic disease. The aim of this study is to describe the frequency and distribution of acute neurologic symptoms occurring in aortic dissection and the distribution of their clinico-pathologic features and to establish correlations between these and the acute in-hospital mortality as well as to discuss available diagnostic and therapeutic possibilities.


METHODS
The study was based of 95 cases of acute dissection of aorta (with additional three later events of redissection), observed in a longitudinal study over a period of 29.5 years, in a population of 106,000 (in Western Hungary).


RESULTS
Of the 95 patients 20 (21%) died before admission. Neurological complications were observed in 30 of the 75 patients admitted to hospital (40%). Symptoms involving the central nervous system were found in 24 patients, affecting the spinal cord in two and the peripheral nervous system in four cases. The dissection of the aorta was diagnosed in vivo only in 22 out of the 75 patients who died in hospital (29%). 53 patients (71%) without correct diagnosis received supportive therapy only. The average survival time of the 21 patients with proximal dissection of aorta was 48.5 hours. The survival time of 23 patients with the same type of dissection involving the vessels of the aortic arch was 22.2 hours. This difference in survival time was significant (p = 0.0152). 20 of 23 patients (87%) in this group showed signs of neurologic damage confirming earlier experience that neurological complications can seriously worsen the otherwise already catastrophic prognosis of aortic dissection.


CONCLUSIONS
The study brought compelling evidence for the need for early diagnosis and rapid transfer of patients to appropriate cardiac surgery centers for definitive diagnosis and therapy.
Városi Kórház és Rendelóintézet, Sümeg.
István
I
Mészáros
József
J
Mórocz
József
J
Szlávi
János
J
Schmidt
László
L
Nagy
Csaba
C
Kató
László
L
Tornóci
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D001014:Aortic Aneurysm / Q000150:complications* / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D015996:Survival Rate