Lee Seung-Jae, Kim Jae-Hyun, Na Chan-Young, Oh Sam-Sae, Kim Yang-Min, Lee Chang-Keun, Lim Dal-Soo
BMC Neurol. 2013 May 21;13:46. doi: 10.1186/1471-2377-13-46.
This study attempts to explore the clinical features, possible mechanisms and prognosis of the neurologic complications in patients with acute aortic dissection (AD).
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.
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.
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.
本研究旨在探讨急性主动脉夹层（AD）患者神经并发症的临床特征、可能机制及预后。
回顾性分析11.5年间连续收治的278例AD患者（165例A型夹层和113例B型夹层）的病历，包括临床病史、CT表现、神经并发症及转归。神经并发症分为早发或迟发并发症。采用独立t检验或卡方检验（或Fisher精确检验）比较不同组间差异。进行多变量逻辑回归分析以确定变量之间的独立关联。
纳入患者（145例男性和133例女性）的平均年龄为59.4岁（范围19 - 91岁）。41例患者（14.7%）出现神经并发症，其中21例为早发并发症，23例为迟发并发症，3例两者均有。高龄和典型夹层类型与A型夹层患者的神经并发症独立相关。最常见的表现为缺血性卒中（26例，9.4%），其次为缺氧性脑病（9例，3.2%）、缺血性神经病（5例，1.8%）、脊髓缺血（5例，1.8%）、癫痫发作（2例，0.7%）、声音嘶哑（1例，0.4%）和脓毒性脑病（1例，0.4%）。总体住院死亡率为10.1%，而并发症组死亡率为43.9%。肾功能损害、脉搏短绌、神经并发症和非手术治疗是决定A型夹层患者住院死亡率的独立变量。
AD早期神经症状占主导可能使其早期诊断困难。除胸痛和胸部X线显示纵隔增宽外，包括左侧偏瘫伴脉搏不对称和低血压在内的各种神经症状可能提示潜在的AD。
