Neurological symptoms in type A aortic dissections

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Title：Neurological symptoms in type A aortic dissections
题目：A型主动脉夹层的神经系统症状
Author：Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ.
Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany. Charly.Gaul@gmx.de

Resource: Stroke. 2007 Feb;38(2):292-7. Epub 2006 Dec 28.

Abstract：BACKGROUND AND PURPOSE: Aortic dissection typically presents with severe chest or back pain. Neurological symptoms may occur because of occlusion of supplying vessels or general hypotension. Especially in pain-free dissections diagnosis can be difficult and delayed. The purpose of this study is to analyze the association between type A aortic dissection and neurological symptoms.
【摘要】背景和目的：典型的主动脉夹层表现为严重的胸痛或背痛，神经系统症状可能由于供血血管的闭塞或全身性的低血压引起。尤其是无痛型的主动脉夹层，其诊断往往比较困难且容易延误病情。本研究的目的是分析A型主动脉夹层与神经系统症状之间的关系。

METHODS: Clinical records of 102 consecutive patients with aortic dissection (63% male, median age 58 years) over 7.5 years were analyzed for medical history, preoperative clinical characteristics, treatment and outcome with main emphasis on neurological symptoms.
方法：收集7.5年中连续收治的102例（男性63％，平均年龄58岁）主动脉夹层患者临床资料，重点分析其强调神经系统症状的病史、术前的临床特征、治疗以及转归。

RESULTS: Thirty patients showed initial neurological symptoms (29%). Only two-thirds of them reported chest pain, and most patients without initial neurological symptoms experienced pain (94%).
结果：30例患者（29％）以神经系统症状首发。仅有2/3患者诉有胸痛，且大多数无NS症状的患者都有疼痛（94％）。

Neurological symptoms were attributable to ischemic stroke (16%), spinal cord ischemia (1%), ischemic neuropathy (11%), and hypoxic encephalopathy (2%). Other frequent symptoms were syncopes (6%) and seizures (3%).
NS症状主要表现为缺血性卒中（16％），脊髓缺血（1％），缺血性神经病（11％），以及缺氧性脑病（2％）。其他常见的症状是晕厥（6％）和癫痫发作（3％）。

In half of the patients, neurological symptoms were transient. Postoperatively, neurological symptoms were found in 48% of all patients encompassing ischemic stroke (14%), spinal cord ischemia (4%), ischemic neuropathy (3%), hypoxic encephalopathy (8%), nerve compression (7%), and postoperative delirium (15%).
NS症状在半数患者中为一过性的。所有患者术后发现NS症状的为48％，其中缺血性卒中14％，脊髓缺血4％，缺血性神经病3％，缺氧性脑病8％，神经压迫7％，术后谵妄15％。

Overall mortality was 23% and did not significantly differ between patients with and without initial neurological symptoms or complications.
总死亡率为23％，且有/无NS症状或并发症的两组患者相比较无显著性差异。

CONCLUSIONS: Aortic dissections might be missed in patients with neurological symptoms but without pain. Neurological findings in elderly hypertensive patients with asymmetrical pulses or cardiac murmur suggest dissection. Especially in patients considered for thrombolytic therapy in acute stroke further diagnostics is essential. Neurological symptoms are not necessarily associated with increased mortality.
结论：有NS症状而无疼痛的主动脉夹层患者容易漏诊。在中老年高血压患者，且心律不齐或有心脏杂音的患者中，其神经病学所见暗示可能有夹层存在。尤其是患有急性卒中准备进行溶栓治疗的患者中，进一步确证尤为必要。NS症状与死亡率增加之间无必然联系。