[Neurologic manifestations of dissecting aneurysms of the aorta].

Dissecting aneurysm of the aorta keeps on being nowadays a diagnostic problem, although it is a well known entity. Dissecting aneurysms may be classified into type A, dissection involving the ascending aorta, and type B, dissection involving descending aorta. The frequency of neurologic manifestations oscillates from 18 to 30%. From the 133 cases of dissecting aneurysm attended at our hospital, 30 (22.5%) presented neurologic manifestations. Nine patients (30%) had symptoms of ischemic neuropathy; 13 (43.3%) presented symptoms compatible with spinal ischemia and 14 (46.7%) presented manifestations of brain ischemia, with involvement of supraaortic trunks proven at autopsy in eight cases. The neurologic complications of type A and B dissecting aneurysms were similar (28 and 26%); in up to 30% of patients, it was the initial symptom. In type A dissecting aneurysm, the most frequent neurologic manifestation was brain ischemia (57.1%) whereas ischemic neuropathy and spinal ischemia predominated in type B dissecting aneurysm. The overall mortality rate reached 76.7% (85.7% for type A and 55.5% for type B). The modality of treatment had no clear influence on the survival. In the presence of brain complications, the mortality was 100%.