Innominate Artery Cannulation for Proximal Aortic Surgery

ABSTRACT Introduction: The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side-graft technique in proximal aortic pathologies. Methods: A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an average age of 56±13 years. The indications for surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%), and ascending aorta pseudoaneurysm in one patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). Three patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta with hemiarch replacement in 34 patients (48.5%). Results: The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and 164+56 minutes, respectively. Mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22°C and 30°C during surgery. Thirty-day mortality rate was 7.1% (five patients). One patient (1.4%) had stroke, one patient (1.4%) had temporary neurologic deficit, and eight patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury. Conclusion: Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides satisfactory neurologic outcomes for proximal aortic surgery.

Neuropathology of COVID-19

The COVID-19 pandemic has placed global health care systems under unprecedented strain but has, at the same time, provided a unique opportunity for pathologists to turn autopsy findings into directly actionable insights into patient care. The current data on the neuropathology of COVID-19 remains preliminary and is limited by the lack of suitable controls, but certain tentative conclusions can be drawn. SARS-CoV-2 can infect multiple cell types in the central nervous system and does so in a subset of patients, although the clinical significance of direct infections remains in the central nervous system (CNS) and the peripheral nervous system (PNS) infections remains unclear. The best-described neuropathological manifestations of COVID-19 in the brain are variable patterns of neuroinflammation and vascular injury, although again, it remains unclear to what degree these findings are specifically due to COVID-19. There is also intriguing preliminary data to suggest a complex relationship between COVID-19 and neurodegeneration, with certain alleles that increase AD risk also increasing the risk of severe COVID-19, and conversely, the possibility that COVID-19 may increase the risk of neurodegenerative disease. The neuropathology of so-called “long-COVID” and the potential effects of COVID-19, or critical illness in general, on neurodegenerative disease remains unclear. There is thus an urgent need for long-term cohort studies of COVID-19 survivors, including brain donation, particularly in elderly patients, with careful recruitment of controls with similar non-COVID inflammatory illnesses.

Neurologic manifestation of Covid-19 pediatric patients admitted at the Philippine Children's Medical Center in the year 2020: a case series

@#<p>Covid-19 which was first documented in the Philippines in January 2020 had spread alarmingly. Severe acute respiratory symptoms were the most common presentation of this novel coronavirus infection. Reports have described neurologic manifestations of this disease involving the central nervous system as well as the peripheral nervous system. However, studies among the pediatric population are limited. In this paper, we present three pediatric patients who were diagnosed with COVID-19, via RT-PCR, presenting with seizures and behavioral changes. Two of these patients have no concomitant respiratory symptoms while the other one had Pediatric Community Acquired Pneumonia. These patients were managed as cases of acute viral meningoencephalitis and were given supportive care.</p>

Neurologic Manifestations according to Serotypes of Enterovirus in Pediatric Inpatient in Incheon

PURPOSE: Enterovirus infection in children can manifest various disease and enterovirus have many serotypes. This study was aimed to investigate neurologic manifestations according to serotypes of enterovirus in pediatric inpatients in Incheon. METHODS: We collected the stool samples from the admitted pediatric patients in Inha University Hospital from January 2015 to September 2016. Enterovirus detection and serotypes identification were performed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) and semi-nested RT-PCR. RESULTS: A total of 527 samples were collected during study period and 170 patients (32.2%) were diagnosed with enterovirus infections. Genetic sequences of enteroviruses were identified: echovirus 18 (50, 40.5%), enterovirus 71 (12, 9.6%), coxakievirus A10 (10, 8.0%), echovirus 6 (7, 5.6%). Virus in patient with meningitis were identified: echovirus 18 (15, 75%), coxakievirus B5 (2, 10%), enterovirus 71 (2, 10%), and echovirus 6 (1, 5%). Neurologic manifestations of echovirus 18 are headache (15, 30%), vomiting (17, 34%), meningeal irritation sign (10, 20.0%). And enterovirus 71 have headache (3, 25%), vomiting (3, 25%), meningeal irritation sign (2, 16.0%), seizure (1, 8.3%), neurologic sequelae (1, 8.3%). Echovirus 18 and neurologic manifestation have a statistically significant correlation with other serotypes (r=0.701, P < 0.01) CONCLUSION: Echovirus 18 infection was more prominent in neurological symptoms than in other serotypes. The major serotype of meningitis was echovirus 18 but there was no reported neurologic sequelae. Enterovirus infection has different neurological symptoms, depending on the serotypes.

Empiema subdural secundario a sinusitis: reporte de caso / Subdural empyema secondary to sinusitis: case report

El empiema subdural es una complicación intracraneana secundaria a sinusitis bacteriana poco frecuente que ocurre generalmenteen varones entre la segunda y tercera década de la vida. Se presenta el caso de un paciente masculino, de 16 años, sinantecedentes, asintomático. Ingresa por cefalea frontoparietal izquierda intensa, compromiso cualitativo de conciencia, calofríos,fiebre y vómitos, sin focalidad neurológica ni signos meníngeos. Resonancia magnética de cerebro muestra colección líquida subduralinterhemisférica en región frontoparietal izquierda que desplaza línea media y sinusitis aguda frontoetmoidomaxilar ipsilateral.Se realiza craniectomía frontoparietal, drenaje quirúrgico y tratamiento antibiótico triasociado intravenoso. Paciente evolucionacon desaparición de síntomas y sin secuelas neurológicas. La clínica del empiema subdural es inespecífica, encontrándose másfrecuentemente cefalea, vómitos, fiebre y compromiso de conciencia. Las imágenes son esenciales para confirmar el diagnósticoy determinar la necesidad de cirugía. Es una patología, cuyo manejo debe ser médico y quirúrgico, comprendiendo drenaje dela colección y terapia antimicrobiana intravenosa. La duración del tratamiento se ha descrito de 3 a 6 semanas. Es necesario unabordaje multidisciplinario precoz para un buen resultado neurológico y funcional, ya que la morbimortalidad se describe hastaun 40%.

The subdural empyema secondary to sinusitis is a rare intracranial complication, which occurs mostly in males in the secondto third decade. We present a case of a 16 years old male patient, without medical history. He is hospitalized for a frontparietalprogressive headache, associated with decreased of consciousness, chills, fever and vomiting, without neurological deficit andmeningeal signs. The magnetic resonance imaging reveals a subdural interhemispheric liquid collection in the left frontparietal regionwith deviation of midline brain structures and left acute frontethmoidmaxilary sinusitis. Craniotomy and surgical drainage withintravenous antibiotic treatment was made. The symptoms dissapear after this and no neurological sequelae was found. The clinicalmanifestation of subdural empyema are inespecific. The more frecuent symptoms are headache, vomit, fever and decreasedof consciousness. The imaging study is essential to diagnose and evaluate the surgical need. The subdural empyema is pathologywith a medical and surgical management; wich involves collection drainage and intravenous antibiotic therapy. It is been describedthat the treatment duration will be prolonged for 3 to 6 weeks. A multidisciplinary approach is necessary for a better neurologicaland functional outcome, because the mortality rates are described up to 40%.

Clinical and pathological characteristics of primary Sj(o)gren's syndrome-associated neurological lesions / 中华全科医师杂志

Objective To explore clinical and pathological characteristics of neurological lesions in primary Sj(o)gren's syndrome (pSS).Methods Ten patients diagnosed as pSS with nervous system involvement were analyzed retrospectively with autoimmune antibody test,cerebrespinal fluid examination and Schivmer's test,six pSS patients with peripheral nervous system lesions (PNS-pSS) were examined with electromyography and nerve conduction velocity and four pSS patients with central nervous system lesions (CNS-pSS) were examined with cranial MRI to analyze their clinical and pathological characteristics.Salivary gland biopsy was performed for all the ten patients,sural nerve biopsy for those with PNS-pSS and brain biopsy or spinal autopsy for those with CNS-pSS.Results Clinically,six patients with PNS-pSS presented symmetrical sensory-motor peripheral neuropathy or pure sensory peripheral neuropathy and four patients with CNS-pSS presented multiple sclerosis,subacute transverse myelitis,encephalitis,pituitary stroke and acute meningitis with varied lesions in the myelin sheath and axon by electromyography and motor nerve conduction velocity.Cranial MRI showed lesions in the white matter of the brain,spinal cord and abnormal signals in the pituitary.Pathologically,sural nerve biopsy showed typical vasculitis and nonvasculitis characterized as degeneration of the axon and myelin sheath,salivary acinar gland biopsy showed its atrophy and infiltration with lymphocytes,and brain biopsy showed demyelination of the brain and spinal white matter,as well as infiltration of lymphocytes surrounding the veins,typical vasculitis and bleeding and necrosis of the pituitary.Conclusions Both central and peripheral nervous systems can be involved in pSS,with complicated clinical manifestations.Electrophysiology,cerebrospinal fluid tests and histopathological examinations by biopsy are essential in diagnosis for neurological lesions in patients with pSS.Inflammatory reaction of the blood vessels and tissues mediated by cell immunity may be involved in mechanism of its neurological lesions.

Clinical analysis of 18 cases of neurosyphilis / 中华皮肤科杂志

Objective To analyze the clinical features, diagnosis, treatment and prognosis of neurosyphilis. Methods Clinical data on and laboratory findings in 18 cases with neurosyphilis collected in the Affiliated Provincial Hospital, Anhui Medical University from 2006 to 2008 were retrospectively studied.Results Among the 18 patients, 3 sufferred from asymptomatic neurosyphilis, 1 from meningeal syphilis, 7 from meningovascular syphilis, 5 from paralytic dementia, and 2 from intracranial space-occupation. Toluidine red unheated serum reagin test (TRUST) and Treponema pallidum particle agglutination test (TPPA) of sera were positive in all the patients; cerebrospinal fluid (CSF) TRUST was positive in 16 patients, and CSF TPPA in all patients. An increase was observed in CSF leukocyte count in 7 patients and in CSF protein in 13 patients.The findings on cerebral magnetic resonance imaging (MRI) mainly included demyelination, brain atrophy,cerebral infarction, etc. All the patients, except 2 with a TRUST titer of 1:4, experienced a 4-fold decrease in TRUST titer within a 3-month follow up. Clinical symptoms of neurosyphilis improved in all patients except 1 with paralytic dementia. Conclusions The diversity of clinical manifestations usually leads to the misdiagnosis of neurosyphilis, which should be diagnosed based on comprehensive analysis of clinical characteristics as well as laboratory and imaging findings. Early diagnosis and treatment are beneficial to its prognosis.

Enterovirus 71-associated hand, foot and mouth diseases with neurologic symptoms, a university hospital experience in Korea, 2009 / 소아과

PURPOSE: Hand-foot-mouth disease (HFMD) is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71) has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital. METHODS: Examinations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed. RESULTS: EV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10) was the most common manifestation, followed by Guillain-Barre syndrome (n=3), meningoencephalitis (n=2), poliomyelitis-like paralytic disease (n=1), and myoclonus (n=1). Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008. CONCLUSION: Because EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease.

Clinical Manifestations of Elderly Patients Admitted Because of Severe Hyponatremia / 대한신장학회지

PURPOSE: Recently the incidence of severe hyponatremia is increasing in old patients but there is no report about clinical findings of old patients with hyponatremia. We evaluated the cause and clinical manifestations of severe hyponatremia in old patients who had been admitted via emergency room. METHODS: We retrospectively reviewed clinical records of the hyponatremic patients who had been admitted from 2000 to 2007. We enrolled 53 patients (Age >60 years, Na <125 mEq/L) without severe liver cirrhosis, heart failure or chronic kidney disease. We analyzed data to evaluate the differences of clinical manifestations according to the presence of symptoms, taking diuretics, urine sodium concentrations and the degree of hyponatremia. RESULTS: Mean serum sodium concentration was 111.4+/-6.9 mEq/L and urine sodium concentration was 68.7+/-43.8 mEq/L. There was no difference in serum sodium concentration according to age. Twenty-nine (54.7%) patients had nausea and vomiting and 19 patients (35.8%) had neurologic symptoms. Patients with neurologic symptoms showed lower serum and urine sodium concentration than patients without neurologic symptoms. The main causes of severe hyponatremia were poor oral intake (79.2%), diuretics use (37.7%) and recent operation (15.1%). The mean sodium concentration of the fluid administered to achieve 125 mEq/L of serum sodium level was 336.5+/-160.6 mEq/L. CONCLUSION: The urinary sodium loss, e.g., diuretics abuse, may be the main cause of severe hyponatremia in elderly patients over 60 years. In elderly patients, diuretics should be carefully administered with frequent electrolyte monitoring.

Epileptic seizures and EEG features in juvenile systemic lupus erythematosus / Crises epilépticas e características do EEG em pacientes com lúpus eritematoso sistêmico juvenil

INTRODUCTION: Juvenile systemic lupus erythematosus is more incident in female affecting different systems including the central nervous system. The aim of this study was to check the incidence of seizures and electroencephalographic features in these patients. METHOD: It was analyzed all patients with juvenile systemic lupus erythematosus referred to the Pequeno Príncipe Hospital in Curitiba, PR, Brazil, in the year of 2007. The patients were submitted to EEG and subdivided into two groups according to the presence or absence of epileptic seizures. Mann-Whitney statistical test was used. RESULTS: Forty-nine cases were included, there were 73.45 percent female, with an age between 3 and 28 years (µ=17.00 years; s=5.01 years). Seizures (13/26.50 percent) were the most frequent manifestation followed by headache (13/26.50 percent) and ischemic stroke (6/12.25 percent). Cerebral vasculites were the most frequent alteration in neuroimage. The abnormalities of EEG were characterized by asymmetry of the electric cerebral activity, diffuse disorganized background activity, focal epileptiform discharges in the right central-temporal region, generalized paroxysmal of 3 Hz spike-waves, and bursts of theta-delta slowness activity in the right parietal-occiptal region. The statistic analysis showed no significantly difference between age of onset of symptoms and the risk of seizures (p 0.675) as well as between time of the disease and the risk of seizures (p 0.436). CONCLUSION: Neurologic manifestations, in special epileptic seizures, are frequent in systemic lupus erythematosus. Age of onset of symptoms and the time of disease did not increase the risk of epileptic seizures in this disease.

INTRODUÇÃO: Lupus eritematoso sistêmico juvenil é doença mais freqüente no sexo feminino afetando múltiplos sistemas, incluindo o sistema nervoso central. O objetivo deste estudo foi avaliar a incidência de crises epilépticas e de alterações eletrencefalográficas nestes pacientes. MÉTODO: Foram avaliados todos os pacientes com lupus eritematoso sistêmico juvenil encaminhados para o Hospital Pequeno Príncipe em Curitiba, PR, Brasil, no ano de 2007. Os pacientes foram submetidos a EEG e subdivididos em 2 grupos conforme a presença ou não de crises epilépticas. A análise foi realizada através do teste estatístico de Mann-Whitney. RESULTADOS: 49 casos foram incluídos, sendo 73,45 por cento do sexo feminino, com idade variando entre 3 e 28 anos (µ=17,00 anos; s=5,01 anos). Crises epilépticas (13/26,50 por cento) foram a manifestação neurológica mais freqüente, seguidas de cefaléia (13/26,50 por cento) e acidente vascular cerebral isquêmico (6/12,25 por cento). Vasculite cerebral foi a alteração de imagem mais freqüente. As alterações no EEG foram caracterizadas por assimetria da atividade elétrica cerebral, desorganização difusa da atividade de base, descargas epileptiformes na região centro-temporal direita, paroxismos generalizados de espícula-onda à 3 Hz e surtos de onda lenta na faixa delta-teta na região parieto-occipital direita. A análise estatística não demonstrou diferença significativa entre a idade de início dos sintomas e risco de crise epiléptica (p 0,675) e nem entre tempo de evolução da doença e risco de crise epiléptica (p 0,436). CONCLUSÃO: Manifestações neurológicas, particularmente crises epilépticas, são freqüentes no lupus eritematoso sistêmico juvenil. A idade de início dos sintomas e o tempo de duração da doença não aumentam o risco de crises epilépticas nesta doença.

Analysis of Factors Related to Neurological Deficit in Thoracolumbar Fractures

OBJECTIVE: The purpose of this study is to determine the factors that have effects on the neurological deficit in the patients with thoracolumbar fracture. METHODS: Forty-eight patients were included. Cause of injury, type of injury, time interval, combined injury, kyphotic angle, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, transverse diameter, the most narrow transverse diameter, and remained height of vertebra body were concerned as the factors. The patients with American Spinal Injury Association(ASIA) impairment scale grade A to D were considered as having neurology while others with ASIA grade E were considered to be without neurology. The patients with ASIA grade A were classified to paraplegia group and the patients with ASIA grade B to E were not thought to be paraplegia. Statistical analysis for these groups were performed. RESULTS: Spinal canal compromise (P<0.001) have correlation with neurological deficit. The most narrow sagittal diameter was smaller in the group with deficit than that in the group without deficit (P=0.004). Also, combined injury have correlation with neurology (P=0.028). Spinal canal compromise (P<0.001), sagittal diameter (P=0.032), the most narrow sagittal diameter (P=0.025), and Denis type (P<0.001) also have correlation with paraplegia. CONCLUSION: The factors of percentage of spinal canal compromise, the most narrow sagittal diameter, and combined injury are predictive of neurological deficit. The patients with paraplegia may be predicted by the factors such as type of injury, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, and Denis type.

A Patient of Sweet Syndrome Associated with Encephalitis

No abstract available.

Neurologic Manifestations of Churg-Strauss Syndrome

BACKGROUND: Churg-Strauss syndrome (CSS) is characterized by disseminated vasculitis with multi-organ involve-ment. The purpose of this study was to determine the frequency and the types of neurologic involvement in a series of patients with CSS. METHODS: We reviewed the medical records of 16 patients (seven men and nine women, age = 41.9 (18.6) with CSS who were examined at Seoul National University Hospital. The diagnosis of CSS was based on the presence of asthma, peripheral eosinophilia (more than 10% eosinophiles), and histopathological or clinical findings of vasculitis. RESULTS: Of the 16 patients, 12 (75%) had neurologic involvement. Nine (56%) had neurologic symptoms as initial presentations of CSS. Peripheral neuropathy was detected in nine patients (56%) ; six had multiple mononeu-ropathy, and three had distal symmetric polyneuropathy. Three patients (19%) had cerebral infarctions; in two of them, a delayed diagnosis of CSS caused the recurrence of ischemic stroke. Corticosteroid therapy combined with immuno-suppressive agents usually yielded improvement or stabilization of symptoms. CONCLUSIONS: Neurologic involvement is common in CSS, usually manifesting as peripheral neuropathy. Neurologic symptoms are important initial manifesta-tions at the time of diagnosis of CSS. Furthermore, cerebral involvement is not uncommon; thus any neurologic symp-toms in patients with asthma or eosinophilia prompts an aggressive diagnostic approach to CSS.

Neurologic Manifestations of Atlanto-axial Subluxation in the Patients with Rheumatoid Arthritis

BACKGROUND: Atlanto-axial dislocation (AAD) is a common complication of rheumatoid arthritis (RA). Diverse or different patterns of neurological manifestations including brainstem signs, myelopathy, vertebrobasilar insufficiency, and radiculopathy are expected in each type of AAD. This study is designed for the evaluation of neurological manifes-tations of AAD in RA, and for the comparison of clinical profiles with radiological findings. METHODS: Thirty patients compatible with radiological criteria of AAD were selected. The age, sex, symptom duration, and neurological signs were evaluated in the clinical profiles. Based on the neurological signs, the patients were classified into three groups. Radiological classifications of AAD were done according to the direction of AAD (anterior, vertical, lateral, mixed) and degrees of dislocation (grade I, II, III). Correlational analysis was performed as a measure of association with the clinical profiles and radiological findings. RESULTS: Neurological manifestations were present/found in 50% of the patients. Each types of AAD were distributed into the following groups:; anterior - 76.7%, mixed - 13.3%, lateral -10%, pure vertical - 0% in our study. The various groups determined by the neurological signs may be correlated with the severity of AAD, especially in the anterior type (> 8mm) and mixed type. Neurological signs were not noted in the pure lateral type. Vascular signs such as vertebrobasilar insufficiency (VBI) were more common in the anterior-AAD, but myelopathic or brainstem signs were more common in the mixed type. CONCLUSIONS: Diverse neurological findings exist in AAD. Different and characteristic manifestations are also noted in each type of AAD. Critical neurological signs including myelopathic, brainstem signs and VBI are prominent in severe anterior-AAD or mixed type.

Neurologic Manifestations of Churg-Strauss Syndrome

BACKGROUND: Churg-Strauss syndrome (CSS) is characterized by disseminated vasculitis with multi-organ involve-ment. The purpose of this study was to determine the frequency and the types of neurologic involvement in a series of patients with CSS. METHODS: We reviewed the medical records of 16 patients (seven men and nine women, age = 41.9 (18.6) with CSS who were examined at Seoul National University Hospital. The diagnosis of CSS was based on the presence of asthma, peripheral eosinophilia (more than 10% eosinophiles), and histopathological or clinical findings of vasculitis. RESULTS: Of the 16 patients, 12 (75%) had neurologic involvement. Nine (56%) had neurologic symptoms as initial presentations of CSS. Peripheral neuropathy was detected in nine patients (56%) ; six had multiple mononeu-ropathy, and three had distal symmetric polyneuropathy. Three patients (19%) had cerebral infarctions; in two of them, a delayed diagnosis of CSS caused the recurrence of ischemic stroke. Corticosteroid therapy combined with immuno-suppressive agents usually yielded improvement or stabilization of symptoms. CONCLUSIONS: Neurologic involvement is common in CSS, usually manifesting as peripheral neuropathy. Neurologic symptoms are important initial manifesta-tions at the time of diagnosis of CSS. Furthermore, cerebral involvement is not uncommon; thus any neurologic symp-toms in patients with asthma or eosinophilia prompts an aggressive diagnostic approach to CSS.

Neurologic Manifestations of Atlanto-axial Subluxation in the Patients with Rheumatoid Arthritis

BACKGROUND: Atlanto-axial dislocation (AAD) is a common complication of rheumatoid arthritis (RA). Diverse or different patterns of neurological manifestations including brainstem signs, myelopathy, vertebrobasilar insufficiency, and radiculopathy are expected in each type of AAD. This study is designed for the evaluation of neurological manifes-tations of AAD in RA, and for the comparison of clinical profiles with radiological findings. METHODS: Thirty patients compatible with radiological criteria of AAD were selected. The age, sex, symptom duration, and neurological signs were evaluated in the clinical profiles. Based on the neurological signs, the patients were classified into three groups. Radiological classifications of AAD were done according to the direction of AAD (anterior, vertical, lateral, mixed) and degrees of dislocation (grade I, II, III). Correlational analysis was performed as a measure of association with the clinical profiles and radiological findings. RESULTS: Neurological manifestations were present/found in 50% of the patients. Each types of AAD were distributed into the following groups:; anterior - 76.7%, mixed - 13.3%, lateral -10%, pure vertical - 0% in our study. The various groups determined by the neurological signs may be correlated with the severity of AAD, especially in the anterior type (> 8mm) and mixed type. Neurological signs were not noted in the pure lateral type. Vascular signs such as vertebrobasilar insufficiency (VBI) were more common in the anterior-AAD, but myelopathic or brainstem signs were more common in the mixed type. CONCLUSIONS: Diverse neurological findings exist in AAD. Different and characteristic manifestations are also noted in each type of AAD. Critical neurological signs including myelopathic, brainstem signs and VBI are prominent in severe anterior-AAD or mixed type.