title: Eleven years of experience with the neurologic complications in Korean patients with acute aortic dissection: a retrospective study.
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.
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Lee
authors.forename: Jae-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Chan-Young
authors.initials: CY
authors.lastname: Na
authors.forename: Sam-Sae
authors.initials: SS
authors.lastname: Oh
authors.forename: Yang-Min
authors.initials: YM
authors.lastname: Kim
authors.forename: Chang-Keun
authors.initials: CK
authors.lastname: Lee
authors.forename: Dal-Soo
authors.initials: DS
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D001014:Aortic Aneurysm / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult