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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical and pathological features of 28 fatal cases of acute uncomplicated massive cerebellar infarction are reviewed. Although infarcts may involve any portion of the cerebellum, they predominantly involve the posteroinferior half of one cerebellar hemisphere. The frequency of acute uncomplicated fatal cerebellar infarction is much greater than previously appreciated, approximating that of acute fatal cerebellar hemorrhage. All patients were past middle age. Atherosclerosis and acute vertebral artery occlusion were the most common etiological factors. The onset was sudden in most cases, with vomiting, dizziness, vertigo, and cerebellar dysfunction. All patients died with progressive brain stem dysfunction and medullary respiratory failure secondary to compression by a swollen cerebellum. Death usually occurred between the third and sixth days following the onset of symptoms, but only six to 30 hours after the onset of obtundation; therefore, decompressive therapy must be instituted promptly.
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PMID:Cerebellar infarction. A clinicopathological study. 113 Oct 69

There is substantial evidence to support the concept that most transient ischemic attacks (TIAs) are caused by microemboli that originate in areas of atherosclerosis in the blood vessels of the neck. TIA's are important risk factors in the development of stroke. The most common clinical features of TIAs caused by carotid insufficiency are hemianesthesia and hemiparesis; other symptoms in these cases include headache, dysphasia, and visual field distrubance. By far the most common clinical manifestation of vertebrobasilar insufficiency is vertigo.
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PMID:Transient ischemic attacks: Pathophysiology and medical management. 126 82

A 34 year old female had a history of dizziness and presyncope. She had many risk factors for atherosclerosis including smoking 30 packs of cigarettes/year, using oral contraceptives (OCs) for almost 10 years, somewhat elevated blood sugars, strong family history of heart disease and diabetes, and hypertension. During an examination in 1983, she had an elevated blood pressure in the right arm but a reading could not be found in the left arm. The physician heard a grade III rough, blowing systolic bruit over the right subclavian artery moving into the right carotid artery. Pulses of both carotid arteries were normal. Heart sounds were normal. While the right brachial and radial pulses were fine, there were none on the left side. Laboratory tests showed a serum cholesterol of 258 mg/dl, a fasting blood sugar of 92 mg/dl, a white blood cell count of 8400, and a normal differential count. The arch aortogram showed a 50-60% stenosis beginning at the innominate artery and a completely occluded left subclavian artery at its origin. Physicians performed an aortoinnominate bypass operation using a Dacron prosthetic graft. This operation alleviated the symptoms, but 2 years later she had bilateral dysesthesias in her upper arms and vertigo returned. Her right arm became more and more limp while her left arm did so mildly. The aortoinnominate graft and the left subclavian artery were occluded. Physicians did coronary angioplasty using the right transfemoral route and corrected both lesions in her brachiocephalic system. they used a technique which eased safe crossing of the occluded subclavian segment (covering the catheter tip with a J curve guidewire). Following the operation, the patient had superb brachial and radial pulses in both arms. Physicians advised her to discontinue using OCs and tobacco products. At months 1 and 5, the symptoms were gone and vital signs were fine.
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PMID:Percutaneous transluminal angioplasty for innominate artery stenosis and total occlusion of subclavian artery in Takayasu's-type arteritis. 256 38

This randomized, double-blind study on 79 patients reported the efficacy of ticlopidine-pentoxifylline combination in the treatment of atherosclerosis and the prevention of cerebrovascular accidents. Comparisons were made with aspirin-dipyridamole-buflomedil and buflomedil-placebo combinations as controls. Global symptoms, sensorimotor disorders and vertigo were improved in all treatment groups, although improvement tended to be more pronounced with ticlopidine-pentoxifylline. None of the groups showed any change in stenosis or vessel wall rigidity although ticlopidine-pentoxifylline reduced flow irregularity. This combination therapy also normalized the direction of flow in the ophthalmic artery in 46.2% of patients with retrograde flow prior to treatment, compared with 30.0% following aspirin-dipyridamole-buflomedil and 28.6% following buflomedil-placebo administration. Significantly fewer cerebrovascular accidents occurred after treatment with ticlopidine-pentoxifylline. In conclusion, ticlopidine-pentoxifylline showed good therapeutic efficacy against atherosclerosis and a preventative effect against new cerebrovascular accidents. This therapy was well tolerated.
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PMID:Ticlopidine-pentoxifylline combination in the treatment of atherosclerosis and the prevention of cerebrovascular accidents. 265 Nov 75

Duplex scanning of the extracranial carotid vessels is a highly reliable medical investigation for identifying atherosclerotic or other pathology in this vascular region. The introduction of this technique into hospital practice has posed the problem of when it is indicated. The present study has shown that almost half the examinations carried out (45.2%) were requested on the basis of what were defined as "general" symptoms (vertigo, lipothymia, migraine, etc.); this group showed a low prevalence of atheromatous plaques. 22.7% of the examinations were requested as a control in the presence of atherosclerosis in another vascular region (coronaries, arteries of the lower extremities, etc.) and in these patients the prevalence of carotid stenosis was high or very high. Patients examined subsequently to a neurological episode came to 15.3% of the total. There was a high prevalence of carotid atheromatous lesions. Numerous controls were requested in subjects with type 2A and 2B hyperlipoproteinaemia (6.7% of the total) with a prevalence of atheromatous lesions higher than the homogeneous-for-age group. A limited number of patients (2%) underwent the study following visual disturbances of presumable ischaemic origin. The prevalence of carotid stenoses in these subjects is high. Patients who underwent carotid TEA (8.1%) represent a special group in whom intervention brings a general improvement although the percentage of vessel restenosis exceeds 20%.
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PMID:[Clinical indications for performing Doppler ultrasonography of the extracranial carotid vessels. A series of 805 subjects]. 267 95

A possible relation between parenteral Depo-Provera and the subsequent development of medullary infarction in a heavy smoker is reported. The patient, a 40-year old Chinese woman had smoked 30 cigarettes daily for many years. She received injections of 150 mg Depo-Provera in April and July 1979. 2 days after the 2nd injection she was admitted to the hospital for vomiting and vertigo of 2 days duration. Clinical examination showed a 12th nerve palsy with the tongue deviated to the right but no other neurological abnormalities. She was treated symptomatically with intravenous fluids and stemetil and improved. On the 5th day her vertigo and vomiting progressed and she developed more lower brain stem signs. The same day she had a grand mal fit and went into a coma. She died on the 7th hospital day. A partial autopsy limited to the skull revealed minimal atherosclerosis of the vertebral artery but no thrombosis or occlusion. Cut sections after perfusion revealed an area of softening associated with some hemorrhage involving the whole length of the right half of the medulla oblongata dorsal to the olivary nucleus. Histological examination revealed an infarct undergoing liquefaction necrosis. The possibility of a causative relationship is suggested by the development of tinnitis about 12 hours after injection of Depo-Provera.
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PMID:Medullary infarction--was it depo-provera? 645 93

From 1982 to 1992, 25 patients with subclavian steal syndrome (SSS) were admitted with 20 undergoing surgery. Etiology included atherosclerosis 56% (14/25), Takayasu's disease 36% (9/25), 14 of them were smokers. Stenosis or occlusion of the left subclavian artery were found in 14, the right in 7, and bilateral in 4. 14 cases had vertigo symptoms, 24 cases had claudication of the arm, 9 of them complained transient ischemic attack (TIA). Carotid to subclavian bypass were performed for 15 cases. Two patients underwent axilloaxillary bypass with evidence of both clinical and laboratory improvement. Aorta-Carotid graft bypass was done in 2 cases with good result in one. PTA was done for a girl with innominate severe stenosis but symptom recurred three months later. Symptoms of the upper extremity ischemia were relieved in 75% of the patients, and of the cerebrovascular ischemia in 50%. Our conclusion is that surgical therapy remains the treatment of choice in symptomatic patients.
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PMID:[Subclavian steal syndrome: a report of 25 cases]. 784 5

The syndrome of chronic vertebrobasilar insufficiency (VBI) consists in a complex of symptoms, often mild and transient, and lacks a complementary system of objective paraclinical investigations able to certify its existence. The study of somato-sensory, auditory and visual evoked potentials in VBI showed the occurrence of changes regardless of the symptom importance both in disorders due to extrinsic causes: a) compression by a damage of the cervical column (92.9%, 50% and 63.9%, respectively; b) diseases of the cervical spinal cord (92.9% and 46.6%, respectively) and in disorders due to some intrinsic vascular causes such as atherosclerosis (62.5%, 88.8% and 87.5%, respectively). We described: a) local and far field modifications for the somesthetic evoked potentials (SEPs); b) modifications due to brain stem hypoxia (vestibular and auditory centres) or of the internal ear for the early and middle auditory potentials (AEPs); c) modifications due to lower perfusion of the occipital lobes and of the nonspecific centres in the brain stem for the visual evoked potentials (VEPs). The N0-P0-Na component of the middle auditory response was considered to represent a vestibular response and it was significantly affected in cases with VBI and clinical manifestations like: equilibrium disorders, nystagmus and vertigo. Typical images of the sensory evoked responses affected by VBI are reproduced considering their evidence as an elective method in the paraclinical examination of this syndrome.
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PMID:Cerebral evoked potentials in the chronic vertebrobasilar insufficiency. 801 85

The territory of the lateral branch of the posterior inferior cerebellar artery (1PICA) supplies the anterolateral region of the caudal part of the cerebellar hemisphere. Because infarcts in the territory of the 1PICA have rarely been studied specifically, 10 patients with this type of infarct are reported. An 1PICA infarct was isolated in only three patients, whereas it was associated with brainstem infarct in four, with occipital infarct in one, and with multiple infarcts in two patients. The most common symptom at onset was acute unsteadiness and gait ataxia without rotatory vertigo (six patients). Unilateral cerebellar dysfunction was found in all patients, with limb ataxia (nine patients), dysdiadochokinesia (five patients), and ipsilateral body sway (four patients), but dysarthria and primary position nystagmus were notably absent. In the patients with a coexisting infarct in the brainstem, cranial nerve and sensorimotor dysfunction was prominent and often masked the signs of cerebellar dysfunction. Unlike other infarcts in the PICA territory, 1PICA territory infarcts were mainly associated with vertebral artery atherosclerosis (six patients), whereas cardiac embolism was less common (three patients). Unilateral limb ataxia without dysarthria or vestibular signs suggests isolated 1PICA territory infarction and should allow its differentiation from other cerebellar infarcts.
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PMID:Infarcts in the territory of the lateral branch of the posterior inferior cerebellar artery. 808 72

Doppler ultrasound examination is an easy and non-invasive examination technique to image the anatomical and functional situation of cervical vessels. An increasing number of ENT-specialists has been using Doppler sonography in the diagnosis of cochlear and vestibular disorders. We analysed the frequency of pathological Doppler examination results of 150 patients with vertigo, hearing loss and tinnitus. Especially patients with vertigo bear a greater risk for stenosis of the extracranial arteries (28%) compared to an asymptomatical population (1%). Patients with hearing loss and tinnitus showed a different degree of artery disorders (23% of the patients with hearing loss; 18% of the patients with tinnitus). Patients bearing no risk for atherosclerosis showed in 13% (vertigo) and 8% (hearing loss and tinnitus) stenosis of the cervical arteries. Thus we found by Doppler ultrasound examination more stenoses in patients with cochlear or vestibular symptoms than in an asymptomatical population. The early attribution of stenosis to a malfunction of the inner ear helps to avoid invasive examinations of cervical vessels. In addition to this, imminent cerebral ischaemia can be revealed at an early stage.
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PMID:[Incidence of Doppler ultrasound detectable stenoses of cervical arteries in patients with cochlear-vestibular symptoms]. 826 28


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