The neurological manifestations of dissecting aneurysm of the aorta.

Six cases of dissecting aneurysm of the aorta, four with cerebral manifestations, one with peripheral neuropathy and one with ischaemic necrosis of the spinal cord are reported. Cerebral manifestations include confusion and stupor, syncope, grand mal epilepsy, ischaemia of the spinal medulla, carotid artery occlusion and cerebral hemisphere infarction. Ischaemic neuropathy is characterized by severe limb pain not of peripheral nerve distribution, but associated with areflexia and a peripheral pattern of sensory loss. Ischaemic necrosis of the cord is characterized by flaccid paraplegia and sphincter disturbances with segmental sensory loss exhibiting an upper level on the trunk. The differential diagnosis of the neurological complications of aortic dissection is discussed and a brief review of advances in management made.