Ying Chieh Huang1,2, Sheng Feng Sung3, Kuan Ting Liu2. 1. Chiayi Christian Hospital Department of Emergency Medicine Chiayi Taiwan. 2. Kaohsiung Medical University Department of Emergency Medicine, Medical Center and School of Medicine Kaohsiung Taiwan. 3. Chiayi Christian Hospital Division of Neurology, Department of Medicine Chiayi Taiwan.
Abstract
INTRODUCTION: Acute aortic dissection (AAD) is a life-threatening emergency. A small portion of AAD patients presents as an acute stroke without chest pain. A missed or delayed diagnosis of AAD often brings catastrophic outcome. We aimed to identify clinical markers suggestive of the presence of painless AAD in acute stroke patients. METHODS: From January 2007 through December 2014, painless AAD patients were retrospectively collected from our stroke registry. We expanded the search by reviewing Medline and the Science Citation Index Expanded from 1981 until March 2015. We enrolled 200 consecutive cases of acute ischemic stroke without AAD as the control. Univariate analyses were performed to compare clinical markers, followed by logistic regression to analyze the markers with signifi cant differences. RESULTS: The AAD group had more female, younger patients and fewer co-morbidities. They more frequently had consciousness disturbances (p < 0.001), were brought to the hospital sooner (p < 0.001), arrived more frequently with impaired consciousness (p = 0.001), hypotension and bradycardia (p < 0.001) and left-sided weakness (70.2%; p < 0.001). In the risk factor analysis, hypotension (OR 48.86, 95% CI 5.70-420.28), bradycardia (OR 8.11, 95% CI 2.71-24.24), initial loss of consciousness (OR 5.27, 95% CI 1.88-14.76), andleft-sided weakness (OR 3.31, 95% CI 1.17-9.40) were observed more frequently in the AAD group. CONCLUSIONS: Consider to rule out a painless AAD in stroke patients presenting with hypotension, bradycardia, initial loss of consciousness, or left-sided weakness.
INTRODUCTION: Acute aortic dissection (AAD) is a life-threatening emergency. A small portion of AAD patients presents as an acute stroke without chest pain. A missed or delayed diagnosis of AAD often brings catastrophic outcome. We aimed to identify clinical markers suggestive of the presence of painless AAD in acute stroke patients. METHODS: From January 2007 through December 2014, painless AAD patients were retrospectively collected from our stroke registry. We expanded the search by reviewing Medline and the Science Citation Index Expanded from 1981 until March 2015. We enrolled 200 consecutive cases of acute ischemic stroke without AAD as the control. Univariate analyses were performed to compare clinical markers, followed by logistic regression to analyze the markers with signifi cant differences. RESULTS: The AAD group had more female, younger patients and fewer co-morbidities. They more frequently had consciousness disturbances (p < 0.001), were brought to the hospital sooner (p < 0.001), arrived more frequently with impaired consciousness (p = 0.001), hypotension and bradycardia (p < 0.001) and left-sided weakness (70.2%; p < 0.001). In the risk factor analysis, hypotension (OR 48.86, 95% CI 5.70-420.28), bradycardia (OR 8.11, 95% CI 2.71-24.24), initial loss of consciousness (OR 5.27, 95% CI 1.88-14.76), andleft-sided weakness (OR 3.31, 95% CI 1.17-9.40) were observed more frequently in the AAD group. CONCLUSIONS: Consider to rule out a painless AAD in stroke patients presenting with hypotension, bradycardia, initial loss of consciousness, or left-sided weakness.
Authors: Javier M Romero; Michael H Lev; Suk-Tak Chan; Molly M Connelly; Ryan C Curiel; Anna E Jackson; R Gilberto Gonzalez; Robert H Ackerman Journal: Radiographics Date: 2002 Sep-Oct Impact factor: 5.333
Authors: Jeffrey J Wing; Jonggyu Baek; Brisa N Sánchez; Lynda D Lisabeth; Melinda A Smith; Lewis B Morgenstern; Darin B Zahuranec Journal: Cerebrovasc Dis Date: 2014-11-25 Impact factor: 2.762
Authors: Seung Woo Park; Stuart Hutchison; Rajendra H Mehta; Eric M Isselbacher; Jeanna V Cooper; Jianming Fang; Arturo Evangelista; Alfredo Llovet; Christoph A Nienaber; Toru Suzuki; Linda A Pape; Kim A Eagle; Jae K Oh Journal: Mayo Clin Proc Date: 2004-10 Impact factor: 7.616
Authors: Werner Hacke; Geoffrey Donnan; Cesare Fieschi; Markku Kaste; Rüdiger von Kummer; Joseph P Broderick; Thomas Brott; Michael Frankel; James C Grotta; E Clarke Haley; Thomas Kwiatkowski; Steven R Levine; Chris Lewandowski; Mei Lu; Patrick Lyden; John R Marler; Suresh Patel; Barbara C Tilley; Gregory Albers; Erich Bluhmki; Manfred Wilhelm; Scott Hamilton Journal: Lancet Date: 2004-03-06 Impact factor: 79.321
Authors: Eduardo Bossone; David C Corteville; Kevin M Harris; Toru Suzuki; Rossella Fattori; Stuart Hutchison; Marek P Ehrlich; Reed E Pyeritz; Philippe Gabriel Steg; Kevin Greason; Arturo Evangelista; Eva Kline-Rogers; Daniel G Montgomery; Eric M Isselbacher; Christoph A Nienaber; Kim A Eagle Journal: Circulation Date: 2013-09-10 Impact factor: 29.690