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  • Updated 02.28.2024
  • Released 06.30.1997
  • Expires For CME 02.28.2027

Aortic diseases: neurologic complications



Diseases or surgeries involving the aorta can produce a wide range of neurologic symptoms, ranging from stroke to peripheral neuropathy and sexual dysfunction. 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 aortic dissections, including the role of tPA and the 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, 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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