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  • Updated 08.29.2019
  • Released 06.30.1997
  • Expires For CME 08.29.2022

Aortic diseases: neurologic complications

Introduction

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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