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CC BY 4.0 · Aorta (Stamford) 2018; 06(06): 130-138
DOI: 10.1055/s-0039-18388
Original Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Head and Neck Pain in Patients Presenting with Acute Aortic Dissection

Stephen Philip
1   Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
,
Emil Missov
2   Department of Internal Medicine, University of Minnesota Physicians Heart Practice, Minneapolis, Minnesota
,
Dan Gilon
3   Department of Non-invasive Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
,
Stuart Hutchison
4   Libin Cardiovascular Institute, University of Calgary Medical Centre, Calgary, Canada
,
Ali Khoynezhad
5   Department of Cardiovascular Surgery, Long Beach Medical Center, Los Angeles, California
,
Arturo Evangelista
6   Department of Cardiology, Hospital General Universitari Vall D'hebron, Barcelona, Spain
,
Mark Bonaca
7   Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts
,
Lori Conklin
8   Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
,
Jehangir Appoo
4   Libin Cardiovascular Institute, University of Calgary Medical Centre, Calgary, Canada
,
Marco Di Eusanio
9   Department of Cardiovascular Surgery, Ospedali Riuniti Ancona, Ancona, Italy
,
Alan Braverman
10   Deparment of Cardiology, Washington University, School of Medicine, St. Louis, Missouri
,
Alberto Forteza
11   Department of Cardiac Surgery, Hospital Universitario Puerta De Hierro, Madrid, Spain
,
Daniel Montgomery
1   Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
,
Christoph Nienaber
12   Cardiology and Aortic Centre, The Royal Brompton & Harefield Nhs Trust, London, United Kingdom
,
Eric Isselbacher
13   Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts
,
Kim Eagle
1   Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
› Author Affiliations Funding This research was generously supported by W.L. Gore & Associates, Inc.; Medtronic; Varbedian Aortic Research Fund; The Hewlett Foundation; the Mardigian Foundation; UM Faculty Group Practice; Terumo; and Ann and Bob Aikens.
Further Information

Publication History

19 July 2017

05 November 2018

Publication Date:
24 April 2019 (online)

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Abstract

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.

Keywords

Head Pain - neck pain - aortic dissection
 

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