Aortic dissection presenting with neurological symptoms: prevalence, clinical features, and diagnostic challenges.

   Objective: to investigate the prevalence and clinical features of aortic dissection in patients presenting with neurological symptoms. To evaluate the characteristics of the disease course and diagnosis depending on the presence of pain syndrome.

   Materials and methods: a retrospective cohort comparative study was conducted using the medical records of 130 patients hospitalized in the State Budgetary Healthcare Institution “Research Institute – Regional Clinical Hospital No. 1 n. a. prof. S.V. Ochapovsky” with a diagnosis of Stanford type A aortic dissection from 2020 to 2024. Patients with aortic dissection and
neurological symptoms were divided into two groups: those with and without pain syndrome. A comparative analysis of risk factors, clinical manifestations, diagnostic data, treatment strategies, and outcomes was performed in both groups, with an assessment of the statistical significance of identified differences.

   Results: all patients had Stanford type A dissection; DeBakey type I was identified in 84 (65 %) patients, and type II in 46 (35 %). Among the 130 patients, 31 (23.8 %) presented with neurological symptoms. In 11 (35 %) of these, the typical pain syndrome was absent. Mortality among patients with neurological manifestations was 71 % (22 out of 31). Comparative analysis showed that a higher frequency of diagnostic errors was observed in the group of patients with neurological symptoms but without pain syndrome (p = 0.02). In this group, there were significantly more women (72.7 % vs. 25 %, p = 0.05), ischemic stroke developed more frequently (36.4 % vs. 5 %, p = 0.02), and a diagnosis of aortic dissection was significantly less often established during life – in 36.4 % of cases, it was confirmed only at autopsy (vs. 5 %, p = 0.02). Patients with neurological symptoms and typical pain demonstrated a higher frequency of hypotension, likely related to more severe vascular disturbances. A clinical case of a painless variant of aortic dissection, manifested by impaired consciousness and monoparesis of the arm, is presented.

   Conclusion: aortic dissection, especially in the presence of neurological symptoms, presents a diagnostic challenge requiring a careful approach to atypical manifestations, such as ischemic stroke. The absence of pain syndrome can complicate diagnosis and delay the initiation of treatment. The
obtained data require further research to improve diagnostic strategies, especially in cases with atypical presentations.

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