Aortic diseases: neurologic complications

Supreet Kaur MD (Dr. Kaur of the University of Florida, Gainesville has no relevant financial relationships to disclose.)
Anna Khanna MD (Dr. Khanna, Interim Director and Chief of the Comprehensive Stroke Center at the University of Florida, Gainesville, has no relevant financial relationships to disclose.)
Christina A Wilson MD PhD (Dr. Wilson of the University of Florida College of Medicine has no relevant financial relationships to disclose.)
Steven R Levine MD, editor. (

Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.

)
Originally released June 30, 1997; last updated March 12, 2018; expires March 12, 2021

This article includes discussion of the neurologic complications of aortic diseases, abdominal aortic aneurysm, aneurysm of the aortic arch, aortitis, aortitis due to atherosclerosis, aortitis due to syphilis, cerebral and brainstem ischemia associated with diseases of the aorta, cerebral steal syndromes, coarctation of the aorta, infectious aortitis, intermittent claudication, noninfectious aortitis, peripheral nerve dysfunction and sexual dysfunction associated with diseases of the aorta, and spinal cord ischemia associated with diseases of the aorta, thoracic aortic aneurysm. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Diseases or operations involving the aorta can produce a wide range of neurologic symptoms, ranging from stroke to peripheral neuropathy and sexual dysfunction. In order to understand the pathophysiological basis of these disturbances, it is necessary to appreciate the vascular anatomy of the aorta and its relationship to the blood supply to the brain, spinal cord, and peripheral nervous system. In this article, the authors review common aortic diseases with neurologic sequelae. The authors also provide updated information on thoracic aortic dissection, including the role of tPA and management of aortic arch atheromatous disease.

Key points

 

• Aortic disease is associated with a broad range of neurologic symptoms (including stroke, spinal cord ischemia, and peripheral neuropathy) and should be considered in the differential diagnosis for these entities.

 

• Aortic dissection may present with focal neurologic deficits in the absence of pain and should not be overlooked, especially if the patient presents with syncope, unequal pulses, and/or a new cardiac murmur.

 

• Thrombolysis with intravenous alteplase for acute stroke symptoms is contraindicated in the setting of an aortic dissection.

 

• The presence of neurologic symptoms should not dissuade from immediate surgical repair of ascending aortic dissection.

Historical note and terminology

The anatomy of the blood supply to the spinal cord was initially described in 19th-century German literature in a series of papers published by Adamkiewicz and Kadyi. Surgical treatment of the aorta began in earnest in the second half of the twentieth century, renewing interest in the clinical neurologic symptoms produced by compromise to the blood supply of the brain, spinal cord, and peripheral nerves.

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