1/11. pathology of a dissecting intracranial aneurysm.The pathological findings of six autopsy cases of dissecting intracranial aneurysm are studied. Clinically, all cases exhibited systemic hypertension or left ventricular hypertrophy. Macroscopically, all cases exhibited rupture of the vertebral artery and subarachnoid hemorrhage. Two types of lesion were present. First, all cases showed the formation of a dilatated pseudoaneurysm with widespread disruption of the entire arterial wall, which was composed of thin adventitia. Second, a medial disruption of the arterial wall and subadventitial dissecting hemorrhage, which formed a false lumen and stenosis of the 'true' lumen of the artery, was also found. However, these lesions were found to be connected to the site of rupture. The autopsy cases within 1 day of onset of intracranial dissecting aneurysm showed the formation of fibrin thrombus, a marked degree of leukocyte infiltration and necrosis of the arterial wall at the site of the lesion. The cases that survived more than 1 week showed smooth muscle cell proliferation, macrophage accumulation and lymphocytic infiltration. No arteriosclerosis was found in any lesion studied. These data suggest that the disruption of the entire arterial wall might initially occur and cause medial disruption and subadventitial hemorrhage. hypertension and arteriosclerosis might function as causal and protective factors in the pathogenesis of dissecting intracranial aneurysms, respectively.- - - - - - - - - - ranking = 1keywords = arteriosclerosis (Clic here for more details about this article) |
2/11. Fatal lipid embolism following intraarterial angiography at an early stage of arteriosclerosis.Intraarterial angiography was performed on a patient with peripheral arterial occlusive disease (Fontaine IIb). No relevant risk factors were known, and a previous angiography had been undertaken without incident. After administration of contrast medium, the patient complained of acute pain in the lower abdomen and both legs, and a sudden rise in blood pressure was observed. The patient subsequently lost consciousness and died within 1.5 h. Postmortem examination showed that death was due to peripheral atheromatous microembolism of lipids, and not cholesterol as is usual in these cases. The differential diagnosis is discussed and a review of the literature is presented.- - - - - - - - - - ranking = 2keywords = arteriosclerosis (Clic here for more details about this article) |
3/11. baroreflex failure as a late sequela of neck irradiation.Combined chemotherapy and radiotherapy increase long-term survival in patients with head and neck tumors. Late complications of treatment, however, are being recognized increasingly. Surgery or radiotherapy of the carotid sinuses or brain stem can evoke labile hypertension and orthostatic intolerance from acute or subacute baroreflex failure. Here we report cases in which chronic baroreflex failure appeared to develop as a late sequela of neck irradiation. Three patients referred for autonomic nervous system function testing had labile blood pressure and chronic orthostatic intolerance that developed years after neck irradiation for cancer. In each patient, heart rate remained constant during performance of the valsalva maneuver, suggesting baroreflex-cardiovagal failure. All 3 patients had virtually zero baroreflex-cardiovagal gain, quantified by interbeat interval-systolic blood pressure relationships after intravenous phenylephrine or nitroglycerine. Ambulatory blood pressure monitoring revealed highly variable blood pressure, with sudden pressor and depressor episodes, a characteristic feature of baroreflex failure. Cardiovagal efferent function, assessed by power spectral analysis of heart rate variability during slow, deep respiration, was normal. Sympathetic noradrenergic efferent function, assessed by cold pressor testing and plasma catecholamine levels during supine rest and orthostasis, was also normal or increased. These findings indicated a primarily afferent lesion. Carotid ultrasonography revealed intimal thickening and atheromatous plaques in all 3 patients. We propose that labile hypertension and orthostatic intolerance can develop as a late sequela of neck irradiation, due to chronic carotid baroreflex failure, which in turn is due to radiation-induced accelerated development of carotid arteriosclerosis. Splinting of carotid sinus mechanoreceptors in rigidified arterial walls would impede detection of alterations in blood pressure and thereby disrupt baroreflex regulation of cardiovagal and sympathetic outflows.- - - - - - - - - - ranking = 0.5keywords = arteriosclerosis (Clic here for more details about this article) |
4/11. hypertension and multicystic kidney.The optimal management of the asymptomatic patient with a multicystic kidney remains a dilemma. The risk of nephrectomy in a neonate or infant with this lesion is small and the morbidity is minimal. The alternative to elective nephrectomy is life-long follow-up with blood pressure determinations, beginning in infancy. We report herein two infants with multicystic kidney (MCK) in whom hypertension was cured by its removal. Since accurate blood pressure measurements are relatively difficult to obtain in infants and since periodic long-term follow-up is difficult in the best of circumstances, we are concerned that hypertension caused by a retained MCK goes undiagnosed perhaps more frequently than a review of the current literature suggests. Such hypertension may result in contralateral renal damage and arteriosclerosis, so that later removal of the MCK may not have a beneficial effect on the elevated blood pressure.- - - - - - - - - - ranking = 0.5keywords = arteriosclerosis (Clic here for more details about this article) |
5/11. A case of adrenal tumor producing renin, aldosterone, and sex steroid hormones.A 27-year-old woman with an adrenal tumor that produced renin and aldosterone, associated with hypertension and adrenogenital syndrome, is described. Severe hypertension, cardiomegaly, a low serum potassium level, clinical symptoms of adrenogenital syndrome, and a left upper abdominal tumor also were found. Endocrinological studies showed that plasma and urinary levels of sex steroid hormones such as dehydroepiandrosterone, androsterone, and testosterone were markedly increased. plasma renin activity, plasma angiotensin ii, and plasma aldosterone levels also were increased markedly, although deoxycorticosterone levels remained within the normal range. The possibility of renovascular hypertension was excluded by angiography of the renal artery and by venous sampling of plasma renin activity. Abnormal elevations in plasma aldosterone levels persisted despite normalization of plasma angiotensin ii by converting enzyme inhibitor administration. It was suspected that this patient had an adrenal tumor producing renin as well as sex steroids and aldosterone. microscopy of the resected tumor revealed that the tumor was composed mostly of cells with large nuclei and light cytoplasm. The tumor contained dehydroepiandrosterone, dehydroepiandrosterone sulfate, testosterone, aldosterone, and renin. Immunohistochemical study showed that some of the tumor cells produced renin. biopsy of the left renal tissue showed evident atrophy of the juxtaglomerular cells and pronounced arteriosclerosis. After resection of the tumor, all blood and urinary levels of the abnormally increased hormones returned to a normal range and an apparent fall of blood pressure was noted. To our knowledge, this is the first report of a renin and aldosterone-producing adrenal tumor associated with hypertension and adrenogenital syndrome.- - - - - - - - - - ranking = 0.5keywords = arteriosclerosis (Clic here for more details about this article) |
6/11. Peripheral renal vascular disease in essential hypertension: hemodynamic, angiographic, and endocrine assessment.Renal hemodynamic (133Xe-washout) and angiographic studies were performed in 46 patients with essential hypertension to demonstrate a possible correlation between graded renal small vessel disease and changes in renal blood flow. In addition, influence of the effects of duration of hypertension, diastolic blood pressure values and renal vein renin activity on hemodynamic and arteriographic findings were evaluated. Our results demonstrate that in patients with accelerated or severe renal small vessel disease the mean and cortical renal blood flow is significantly reduced (P less than 0.001). Furthermore, renal arteriosclerosis becomes evident in patients with long-standing hypertension, high diastolic blood pressure values, and elevated renal vein renin levels. Correlations between renal blood flow and renal vein renin activity (r = 0.45) apparently are governed by severity of the renal arteriosclerosis.- - - - - - - - - - ranking = 1keywords = arteriosclerosis (Clic here for more details about this article) |
7/11. Hypertensive choroidopathy.Ocular manifestations of hypertension involve both retinal and choroidal circulation. Clinical and pathological studies suggest that choroidal changes are present in benign and malignant hypertension, though significantly greater in the later. Lesions classically described as Siegrist and Elschnig spots are described. Clinical evidence of choroidopathy from hypertension and arteriosclerosis has a significant prognostic value for life.- - - - - - - - - - ranking = 0.5keywords = arteriosclerosis (Clic here for more details about this article) |
8/11. Familial young-adult-onset arteriosclerotic leukoencephalopathy with alopecia and lumbago without arterial hypertension.Here we review a total of 17 patients, including 4 of our own, with young-adult-onset arteriosclerotic leukoencephalopathy, alopecia and lumbago without hypertension. All were Japanese and the illness seemed to be transmitted in an autosomal recessive fashion. The male to female ratio was 7.5:1. The age of onset usually ranged from 25 to 30 years. Acute lumbago, spondylosis deformans, diffuse baldness, and progressive motor and mental deterioration were common clinical features. Cerebral arteriosclerosis and white mater disease were demonstrated pathologically or radiologically. Although the pathogenesis has remained obscure, we think this is a new clinico-pathological entity distinct from the classic type of Binswanger's disease.- - - - - - - - - - ranking = 0.5keywords = arteriosclerosis (Clic here for more details about this article) |
9/11. An autopsy case of Binswanger's disease without hypertension and associated with cerebral infarction in the terminal stage.We report here an autopsy case of Binswanger's disease (BD) without hypertension and associated with cerebral infarction in the terminal stage. The female patient, who was 74 years old at the time of death, had initially demonstrated manic-depressive disorder-like mental disorder, followed by dementia and neurological deficits. A brain CT scan showed white matter low attenuation bilaterally and symmetrically. BD was clinically diagnosed despite the lack of hypertension. In the terminal stage, she suffered an infarction in the left anterior cerebral artery region, and died of pneumonia. Neuropathologically, we found the infarction of the left anterior cerebral artery region, demyelination, fibrillary gliosis, lacunae and arteriosclerosis of the small arteries and arterioles in the white matter.- - - - - - - - - - ranking = 0.5keywords = arteriosclerosis (Clic here for more details about this article) |
10/11. Thrombus and branch retinal vein occlusion.Branch retinal vein occlusion (BRVO) is often associated with arteriosclerosis. Typically the occlusion occurs at an arteriovenous crossing. We report a case of a previously healthy patient who developed a BRVO. Funduscopy and fluorescein angiography suggested an intravascular thrombus as the cause of the occlusion. The investigations performed were positive for systemic hypertension and hyperlipidaemia. After 2 months, fundus examination revealed disappearance of the intravascular thrombus, resolution of the macular edema and improvement of the visual acuity. Certain physiological characteristics of the retinal circulation associated with hyperlipidaemia and systemic hypertension appear to favour thrombus formation.- - - - - - - - - - ranking = 0.5keywords = arteriosclerosis (Clic here for more details about this article) |
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