Clinical Neuroscience

[Neurologic complications of aortic dissection]

MÉSZÁROS István, MÓROCZ József, SZLÁVI József, SCHMIDT János, NAGY László, KATÓ Csaba, TORNÓCI László

JUNE 20, 2002

Clinical Neuroscience - 2002;55(05-06)

[Introduction - Beside the damages of the cardiovascular system the lesions of the the nervous system are the most common complications of aortic dissection. This is usually an early event, therefore the dissection of the aorta may manifest itself as an acute primary neurologic disease. The aim of this study is to describe the frequency and distribution of acute neurologic symptoms occurring in aortic dissection and the distribution of their clinico-pathologic features and to establish correlations between these and the acute inhospital mortality as well as to discuss available diagnostic and therapeutic possibilities. Patients and methods - The study was based of 95 cases of acute dissection of aorta (with additional three later events of redissection), observed in a longitudinal study over a period of 29.5 years, in a population of 106 000 (in Western Hungary). Results - Of the 95 patients 20 (21%) died before admission. Neurological complications were observed in 30 of the 75 patients admitted to hospital (40%). Symptoms involving the central nervous system were found in 24 patients, affecting the spinal cord in two and the peripheral nervous system in four cases. The dissection of the aorta was diagnosed in vivo only in 22 out of the 75 patients who died in hospital (29%). 53 patients (71%) without correct diagnosis received supportive therapy only. The average survival time of the 21 patients with proximal dissection of aorta was 48.5 hours. The survival time of 23 patients with the same type of dissection involving the vessels of the aortic arch was 22.2 hours. This difference in survival time was significant (p=0.0152). 20 of 23 patients (87%) in this group showed signs of neurologic damage confirming earlier experience that neurological complications can seriously worsen the otherwise already catastrophic prognosis of aortic dissection. Conclusions - The study brought compelling evidence for the need for early diagnosis and rapid transfer of patients to appropriate cardiac surgery centers for definitive diagnosis and therapy.]



Further articles in this publication

Clinical Neuroscience

[The 6th National Congress of Hungarian Chapter of International League against Epilepsy]

Clinical Neuroscience

[Identification of gliomas by morphological and immunocytochemical analysis in cell cultures]


[Introduction - The morphology and immunocytochemical properties of 250 different monolayer cultures derived from various human brain tumor specimens were investigated on purpose to support and complement the neuropatholgical diagnosis. In this study analyses of 124 glioma cases are presented. Methods - The tumor samples were mechanically dissociated and seeded on glass coverslips. After the formation of the monolayer cultures were fixed and stained by May-Grünwald- Giemsa method for the morphological examination. Semi-quantitative immunocytochemical labeling included several different types of mono- and polyclonal primary antibodies using avidin-biotin visualization system. In nine cases of the glioblastomas the sufficient proliferation made possible to establish cell lines from the primary cultures. Results - The glial origin of the tumors was identified in 124 cases based upon the presence of glial fibrillary acidic protein. A negative correlation between the intensity of glial fibrillary acidic protein immunostaining and the grade of tumor malignancy was found. During long-term cultivation of the higher grade gliomas the incidence and intensity of glial fibrillary acidic protein labeled cells was decreasing. Both the vimentin and the neuron specific enolase labeling were in general stronger than the glial fibrillary acidic protein and almost all the cells were stained. The incidence of Ki-67 positive cells increased with the grade of malignancy. Concerning the tumor classification our immunocytochemical results correlated with the routine histopathological examination. Conclusions - On the basis of these results we conclude that monolayer cultures obtained from tumor specimens can support and complement the correct diagnosis of the various human brain tumors.]

Clinical Neuroscience

[The Future of Neuro-rehabilitation]

FÁY Veronika, URBÁN Erika, SZÉPNÉ Kontra Andrea

Clinical Neuroscience

[The Congress of the American Neuro-ophthalmological Society (NANOS)]


Clinical Neuroscience

[In remembrance of Kálmán Sántha, on his 45th death anniversary]


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Clinical Neuroscience

[Thrombolysis in case of ischemic stroke caused by aortic dissection]

LANTOS Judit, NAGY Albert, HEGEDŰS Zoltán, BIHARI Katalin

[Seldom, an acute aortic dissection can be the etiology of an acute ischemic stroke. The aortic dissection typically presents with severe chest pain, but in pain-free dissection, which ranges between 5-15% of the case, the neurological symptoms can obscure the sypmtos of the dissection. By the statistical data, there are 15-20 similar cases in Hungary in a year. In this study we present the case history of an acute ischemic stroke caused by aortic dissection, which is the first hungarian publication in this topic. A 59-year-old man was addmitted with right-gaze-deviation, acute left-sided weakness, left central facial palsy and dysarthric speech. An acute right side ischemic stroke was diagnosed by physical examination without syptoms of acute aortic dissection. Because, according to the protocol it was not contraindicated, a systemic intravenous thrombolysis was performed. The neurological sypmtoms disappeared and there were no complication or hypodensity on the brain computed tomography (CT). 36 hours after the thrombolysis, the patient become restlessness and hypoxic with back pain, without neurological abnormality. A chest CT was performed because of the suspition of the aortic dissection, and a Stanford-A type dissection was verified. After the acute aortic arch reconstruction the patient died, but there was no bleeding complication at the dissection site caused by the thrombolysis. This case report draws attention to the fact that aortic dissection can cause acute ischemic stroke. Although it is difficult to prove it retrospectively, we think the aortic dissection, without causing any symptoms or complain, had already been present before the stroke. In our opinion both the history of our patient and literature reviews confirms that in acute stroke the thrombolysis had no complication effect on the aortic dissection but ceased the neurological symptoms. If the dissection had been diagnosed before the thrombolysis, the aortic arch reconstruction would have been the first step of the treatment, without thrombolysis. ]

Lege Artis Medicinae

[Transesophageal and transthoracic echocardiography in aortic dissection]


[ The severe prognosis of aortic dissection can only be improved by early diagnosis. The role of echocardiography was assessed. Echocardiographic findings were analysed in 32 patients in whom aortic dissection was confirmed by other methods between September 1984 and July 1991. In 19 of them only transthoracic echo (TTE), in 13 patients both TTE and transesophageal echo (TEE) was performed. Control group consisted of 21 patients in whom the clinical suspicion of dissection was ruled out. The DeBakey classification was used. Among 14 acute and 18 chronic cases type I was confirmed in 9, type II in 15 and type III in 8. The sensitivity of clinical suspicion, TTE, TEE and angiography was 34, 72, 92, 94% resp. TEE correctly identified the types, entry and reentry sites, false lumen and left coronary ostium. TTE was valuable in the detection of complications and of etiologic factors of dissection. Hypertension (12) and Marfan's syndrome (7) were the leading etiologic factors. As previously has been reported in the diagnosis of aortic dissection TEE was a safe and reliable technique. It was superior to TTE and was as correct as angiography. The combined use of TTE and TEE is recommended in each case of clinically suspected dissection. The importance of the echocardiographic detection of cardiac complications and etiologic factors is emphasized in the management and prevention.]

Clinical Neuroscience

A variant of Guillain-Barre syndrome after SARS-CoV-2 vaccination: AMSAN

TUTAR Kaya Nurhan, EYIGÜRBÜZ Tuğba, YILDIRIM Zerrin, KALE Nilufer

Introduction - Coronavirus disease 2019 (COVID-19) is a respiratory infection that has rapidly become a global pandemic and vaccines against SARS-CoV-2 have been developed with great success. In this article, we would like to present a patient who developed Guillain-Barré syndrome (GBS), which is a serious complication after receiving the inactive SARS-CoV-2 vaccine (CoronaVac). Case report – A 76-year-old male patient presented to the emergency department with nine days of progressive limb weakness. Two weeks prior to admission, he received the second dose of CoronaVac vaccine. Motor examination revealed decreased extremity strength with 3/5 in the lower extremities versus 4/5 in the upper extremities. Deep tendon reflexes were absent in all four extremities. Nerve conduction studies showed predominantly reduced amplitude in both motor and sensory nerves, consistent with AMSAN (acute motor and sensory axonal neuropathy). Conclusion - Clinicians should be aware of the neuro­logical complications or other side effects associated with COVID-19 vaccination so that early treatment can be an option.