ANEURYSMA DISSECANS OF THE AORTA AS A CAU SE OF AN UNUSUAL NEUROLOGICAL EMERGENCY

Dissecting aortic aneurysms are a very rare clinical entity with a hig h mortality. Clinical symptomatology is very uncharacteristic. Neurolo gical complications are usually due to ischemia and affect brain, spin al cord and peripheral nerves. Our report presents 6 patients (2 women , 4 men, ranging in age from 41 to 88 years) in whom the dissecting an eurysm first became manifest through neurological symptoms. Two patien ts suddenly became unconscious and were comatose on admission. One of these showed a left-sided spastic hemiparesis while the cranial CT rev ealed a diffuse edema of the right hemisphere. The other patient showe d no focal neurological deficit. An 88-year-old patient complained of thoracic pain and paresthesias in the right leg, while a 68-year-old p atient had moderate paresis of the left leg. In a further case there w as nuchal rigidity, aphasia as well as paresis of the right arm. A 41- year-old patient had a grand mal seizure as the first clinical sign. 5 of the 6 patients gave a history of marked thoracic or abdominal pain independent of position. Subsequently 4 of the 6 patients died of sud den vascular death on our intensive care unit. 2 patients underwent em ergency operations and one of these survived. Autopsy of deceased pati ents yielded the diagnosis of an idiopathic, cystic media necrosis of Erdheim-Gsell. If the history or clinical findings (intermittent decre ase or absence of the pulse) point to an aortic aneurysm, then the dia gnosis should be confirmed by X-ray and CT of the thorax, echocardiogr aphy and aortography. The poor prognosis can only be improved by immed iate surgery.