Clinical analysis of aortic dissection with sudden coma and paraplegia as the main symptoms

Abstract

Objective: This study aimed to investigate the clinical characteristics of patients with aortic dissection presenting with neurological symptoms as the initial symptoms. Methods: Clinical characteristics, radiological abnormalities, and prognosis were analyzed in two female patients with aortic dissection. The main clinical symptoms were sudden coma and paraplegia. A detailed clinical examination was performed and computed tomography scans were evaluated. Results: The initial symptoms of the patients involved the nervous system. Chest and abdominal computed tomography scans were performed to confirm the diagnosis of aortic dissection. Both patients died. Conclusion: Patients who present with nervous system symptoms as the first symptoms of aortic dissection, which lead to misdiagnosis and missing the diagnosis, are rare. Improvement in the understanding of this disease is required to ensure that patients receive a timely diagnosis in the early stages.

Aortic Dissection as the Culprit for Seizure

“…Aortic dissection involves aortic blood entering the middle layer of the aortic wall through intimal rupture [ 4 ]. This can then extend and dissect along the longitudinal axis of the aorta [ 4 ]. A major risk factor is hypertension.…”

“…Other risk factors include atherosclerosis, trauma, congenital aortic valve abnormalities, and Marfan syndrome [ 7 ]. Patients present with symptoms depending on the location of the affected blood vessels as well as the anatomical structures nearby [ 4 ].…”

“…In terms of management, type A dissections are surgical emergencies and type B aortic dissections are medically managed [ 2 ]. The mortality rate increases 2% per hour for a type A dissection [ 4 ].…”

“…Risk factors for aortic dissection include a connective tissue disease, family history of aortic disease, and a known thoracic aortic aneurysm, none of which the patient had [ 4 ]. Patients can present with a wide variety of symptoms, making the diagnosis for aortic dissection difficult [ 5 ].…”

“…The neurological complications of aortic dissection include neurological deficits similar in presentation to an ischemic stroke or coma, transient ischemic attack, spinal cord ischemia (involving paraplegia), ischemic neuropathy, as well as hypoxic-ischemic encephalopathy [ 4 ]. Other complications include syncope, generalized tonic-clonic seizures, somnolence, and altered mental status [ 5 ].…”