Neurological symptoms in aortic dissection: a challenge for neurologists

Area of Science:

• Cardiology
• Neurology
• Vascular Surgery

Background:

• Aortic dissection is typically considered in patients with acute thoracic/abdominal pain and cardiovascular symptoms.
• Neurologists are often not involved in routine emergency management due to the typical presentation.
• Neurological symptoms are frequent (17-40%) and can mask the underlying aortic dissection.

Purpose of the Study:

• To highlight the importance of considering aortic dissection in patients presenting with neurological symptoms.
• To emphasize the diagnostic challenges, especially in pain-free cases.
• To underscore the risks associated with misdiagnosis and inappropriate treatment.

Main Methods:

• Review of clinical presentations of aortic dissection.
• Analysis of the frequency and nature of neurological symptoms in aortic dissection.
• Discussion of diagnostic pitfalls and management implications.

Main Results:

• Neurological symptoms (transient or permanent) occur in 17-40% of aortic dissection patients.
• Pain-free dissection with neurological symptoms (5-15%) poses diagnostic challenges.
• Thrombolysis for suspected stroke without considering aortic dissection can be fatal.
• Physical examination findings and chest X-rays can aid diagnosis.

Conclusions:

• Neurological symptoms at the onset or postoperatively do not necessarily increase mortality in aortic dissection.
• Increased awareness and diagnostic vigilance are essential for neurologists and emergency physicians.
• Prompt diagnosis of aortic dissection is critical to prevent misdiagnosis and ensure appropriate management.