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Head and Neck Pain in Patients Presenting with Acute Aortic Dissection
Background Head and neck pain is an atypical presentation of acute aortic dissection. Classic teaching associates this pain with proximal dissections, but this has not been extensively studied. Methods Patients enrolled in the International Registry of Acute Aortic Dissection from January 1996 to...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Thieme Medical Publishers
2019
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482025/ https://www.ncbi.nlm.nih.gov/pubmed/31018236 http://dx.doi.org/10.1055/s-0039-18388 |
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author | Philip, Stephen Missov, Emil Gilon, Dan Hutchison, Stuart Khoynezhad, Ali Evangelista, Arturo Bonaca, Mark Conklin, Lori Appoo, Jehangir Di Eusanio, Marco Braverman, Alan Forteza, Alberto Montgomery, Daniel Nienaber, Christoph Isselbacher, Eric Eagle, Kim |
author_facet | Philip, Stephen Missov, Emil Gilon, Dan Hutchison, Stuart Khoynezhad, Ali Evangelista, Arturo Bonaca, Mark Conklin, Lori Appoo, Jehangir Di Eusanio, Marco Braverman, Alan Forteza, Alberto Montgomery, Daniel Nienaber, Christoph Isselbacher, Eric Eagle, Kim |
author_sort | Philip, Stephen |
collection | PubMed |
description | Background Head and neck pain is an atypical presentation of acute aortic dissection. Classic teaching associates this pain with proximal dissections, but this has not been extensively studied. Methods Patients enrolled in the International Registry of Acute Aortic Dissection from January 1996 to March 2015 were included in this study. We analyzed the demographics, presentation, treatment, and outcomes of Type A aortic dissection patients presenting with head and neck pain ( n = 812, 25.8%) and compared it with those without these symptoms ( n = 2,341, 74.2%). Results Patients with head and neck pain were more likely to be white, female, with a family history of aortic disease. Patients with head and neck pain had higher percentages of back pain (43.3% vs. 37.5%, p = 0.005) and chest pain (87.6% vs. 79.3%, p < 0.001). On imaging, a higher percentage of those with head and neck pain had arch vessel involvement (44.3% vs. 38%, p = 0.010) and intramural hematoma (11.7% vs. 8.1%, p = 0.003). Surgical management was more common in patients with head and neck pain (89.8% vs. 85.2%, p = 0.001). Regarding outcomes, patients with head and neck pain had significantly higher rates of stroke than those without head and neck pain (13% vs. 9.9%, p = 0.016); however, overall mortality was lower for those with head and neck pain (19.5% vs. 23%, p = 0.038). Those with head and neck pain only had higher overall mortality compared to those with head and neck pain with chest or back pain (34.6% vs. 19.9%, p = 0.013). A logistic regression of mortality revealed that preoperative hypotension and age > 65 years were significantly associated with increased mortality. Conclusion Presence of head and neck pain in Type A dissection is associated with more arch involvement, intramural hematoma, and stroke. When isolating those with head and neck pain only, there appear to be a higher rate of comorbidity burden and higher overall mortality. |
format | Online Article Text |
id | pubmed-6482025 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Thieme Medical Publishers |
record_format | MEDLINE/PubMed |
spelling | pubmed-64820252019-04-25 Head and Neck Pain in Patients Presenting with Acute Aortic Dissection Philip, Stephen Missov, Emil Gilon, Dan Hutchison, Stuart Khoynezhad, Ali Evangelista, Arturo Bonaca, Mark Conklin, Lori Appoo, Jehangir Di Eusanio, Marco Braverman, Alan Forteza, Alberto Montgomery, Daniel Nienaber, Christoph Isselbacher, Eric Eagle, Kim Aorta (Stamford) Background Head and neck pain is an atypical presentation of acute aortic dissection. Classic teaching associates this pain with proximal dissections, but this has not been extensively studied. Methods Patients enrolled in the International Registry of Acute Aortic Dissection from January 1996 to March 2015 were included in this study. We analyzed the demographics, presentation, treatment, and outcomes of Type A aortic dissection patients presenting with head and neck pain ( n = 812, 25.8%) and compared it with those without these symptoms ( n = 2,341, 74.2%). Results Patients with head and neck pain were more likely to be white, female, with a family history of aortic disease. Patients with head and neck pain had higher percentages of back pain (43.3% vs. 37.5%, p = 0.005) and chest pain (87.6% vs. 79.3%, p < 0.001). On imaging, a higher percentage of those with head and neck pain had arch vessel involvement (44.3% vs. 38%, p = 0.010) and intramural hematoma (11.7% vs. 8.1%, p = 0.003). Surgical management was more common in patients with head and neck pain (89.8% vs. 85.2%, p = 0.001). Regarding outcomes, patients with head and neck pain had significantly higher rates of stroke than those without head and neck pain (13% vs. 9.9%, p = 0.016); however, overall mortality was lower for those with head and neck pain (19.5% vs. 23%, p = 0.038). Those with head and neck pain only had higher overall mortality compared to those with head and neck pain with chest or back pain (34.6% vs. 19.9%, p = 0.013). A logistic regression of mortality revealed that preoperative hypotension and age > 65 years were significantly associated with increased mortality. Conclusion Presence of head and neck pain in Type A dissection is associated with more arch involvement, intramural hematoma, and stroke. When isolating those with head and neck pain only, there appear to be a higher rate of comorbidity burden and higher overall mortality. Thieme Medical Publishers 2019-04-24 /pmc/articles/PMC6482025/ /pubmed/31018236 http://dx.doi.org/10.1055/s-0039-18388 Text en https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Philip, Stephen Missov, Emil Gilon, Dan Hutchison, Stuart Khoynezhad, Ali Evangelista, Arturo Bonaca, Mark Conklin, Lori Appoo, Jehangir Di Eusanio, Marco Braverman, Alan Forteza, Alberto Montgomery, Daniel Nienaber, Christoph Isselbacher, Eric Eagle, Kim Head and Neck Pain in Patients Presenting with Acute Aortic Dissection |
title | Head and Neck Pain in Patients Presenting with Acute Aortic Dissection |
title_full | Head and Neck Pain in Patients Presenting with Acute Aortic Dissection |
title_fullStr | Head and Neck Pain in Patients Presenting with Acute Aortic Dissection |
title_full_unstemmed | Head and Neck Pain in Patients Presenting with Acute Aortic Dissection |
title_short | Head and Neck Pain in Patients Presenting with Acute Aortic Dissection |
title_sort | head and neck pain in patients presenting with acute aortic dissection |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482025/ https://www.ncbi.nlm.nih.gov/pubmed/31018236 http://dx.doi.org/10.1055/s-0039-18388 |
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