Aortic dissection and delirium
Type of spiritual experienceHallucination
The ultimate cause is pain and hypoxia.
Aortic dissection occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the wall of the aorta, forcing the layers apart. In most cases this is associated with severe characteristic chest or abdominal pain described as "tearing" in character, and often with other symptoms that result from decreased blood supply to other organs. Aortic dissection is a medical emergency and can quickly lead to death, even with optimal treatment, as a result of decreased blood supply to other organs, cardiac failure, and sometimes rupture of the aorta. Aortic dissection is more common in those with a history of high blood pressure, a known thoracic aortic aneurysm, and in a number of conditions that affect blood vessel wall integrity such as Marfan syndrome and the vascular subtype of Ehlers–Danlos syndrome. The diagnosis is made with medical imaging (computed tomography, magnetic resonance imaging or echocardiography).
A description of the experience
Stroke. 2007 Feb;38(2):292-7. Epub 2006 Dec 28. Neurological symptoms in type A aortic dissections. Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ. Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany. Charly.Gaul@gmx.de
BACKGROUND AND PURPOSE: Aortic dissection typically presents with severe chest or back pain. Neurological symptoms may occur because of occlusion of supplying vessels or general hypotension. Especially in pain-free dissections diagnosis can be difficult and delayed. The purpose of this study is to analyze the association between type A aortic dissection and neurological symptoms.
METHODS: Clinical records of 102 consecutive patients with aortic dissection (63% male, median age 58 years) over 7.5 years were analyzed for medical history, preoperative clinical characteristics, treatment and outcome with main emphasis on neurological symptoms.
RESULTS: Thirty patients showed initial neurological symptoms (29%). Only two-thirds of them reported chest pain, and most patients without initial neurological symptoms experienced pain (94%). Neurological symptoms were attributable to
- ischemic stroke (16%),
- spinal cord ischemia (1%),
- ischemic neuropathy (11%), and
- hypoxic encephalopathy (2%).
Other frequent symptoms were syncopes (6%) and seizures (3%). In half of the patients, neurological symptoms were transient. Postoperatively, neurological symptoms were found in 48% of all patients encompassing
- ischemic stroke (14%),
- spinal cord ischemia (4%),
- ischemic neuropathy (3%),
- hypoxic encephalopathy (8%),
- nerve compression (7%), and
- postoperative delirium (15%).
Overall mortality was 23% and did not significantly differ between patients with and without initial neurological symptoms or complications.
CONCLUSIONS: Aortic dissections might be missed in patients with neurological symptoms but without pain. Neurological findings in elderly hypertensive patients with asymmetrical pulses or cardiac murmur suggest dissection. Especially in patients considered for thrombolytic therapy in acute stroke further diagnostics is essential. Neurological symptoms are not necessarily associated with increased mortality.