Electronic Letters to:
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eLetters: Electronic letters published:
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![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Re: Confusion over rupture and dissection
- David Fitzpatrick, Dr Donogh Maguire, Emergency Medicine Consultant (25 October 2007)
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Confusion over rupture and dissection
- Matt J Reed (20 September 2007)
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David Fitzpatrick, Paramedic/Research and Development Officer NMAHP Research Unit, University of Stirling/Scottish Ambulance Service, Dr Donogh Maguire, Emergency Medicine Consultant
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david.fitzpatrick{at}stir.ac.uk David Fitzpatrick, et al.
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Reply to confusion of Rupture and Dissection We thank Dr Reid for his comments regarding the above paper. The case described related to a seventy-three year old gentleman who was found sitting at the wheel of his car in a collapsed state with a left-sided hemiplegia. The patient was found to regain full power of his left side when laid flat. This postural alteration in his neurological symptoms was the point of interest which we were seeking to elucidate, as this patient was subsequently found at post mortem to have a ruptured abdominal aortic aneurysm with no thoracic involvement. These neurological symptoms were attributed to quiescent carotid artery disease (which was subsequently revealed at post mortem). This carotid artery disease manifested with a left sided hemiplegia in the context of severe postural hypotension which had resulted from rupture of his abdominal aortic aneurysm. Dissection of Thoracic Aortic Aneurysm frequently manifests in neurological signs not dissimilar to the initial presentation of this patient. It was for this reason that papers relating to DTAA were referenced. We hope this clarifies the confusion expressed by Dr Reid. |
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Matt J Reed, Consultant in Emergency Medicine Emergency Department, Royal Infirmary of Edinbugh
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mattreed1{at}hotmail.com Matt J Reed
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The authors of the above paper, whilst admirably attempting to highlight the well recognised presentation of a dissecting aorta with neurological symptoms, have unfortunately confused two very distinct diseases with two very different distinct pathologies; those of a ruptured abdominal aneurysm and a dissecting thoracic aorta. The abdominal aorta is prone to aneurysmal dilatation, which can rupture spontaneously causing severe abdominal pain and cardiovascular collapse. The thoracic aorta is not however prone to this complication, however is prone, much less commonly, to tear. This leads to blood tracking between the layers of the aorta. This condition presents with chest pain radiating to the back and not uncommonly presents with neurological complications due to the blocking off of the carotid vessels by blood in the false lumen. It is not clear from the report, which of the two conditions the patient had although it seems likely that this was a dissecting aorta. The authors report a case of a ruptured AAA, but quote references from dissecting aortas and confuse the two pathologies repeatedly throughout the discussion. This mistake should have realised during the review process and an erratum should be published in order not to further confuse the prehospital readers between the two conditions. |
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