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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A successful case of two-staged operation for Stanford type B acute dissecting aneurysm complicated with total occlusion of the distal abdominal aorta was reported. A 62-year-old male patient with a long history of systemic hypertension developed acute severe chest, back and bilateral legs pain. An enhanced CT demonstrated Stanford type B dissecting aneurysm with occlusion of the left renal artery and bilateral common iliac arteries. On the day of admission, an emergent right axillo-femoral bypass operation using 8 mm ringed EPTFE graft was undertaken to rescue the ischemic legs. The patient's postoperative course was complicated with acute renal failure and paralytic ileus, which were treated with medical treatment. Four months later, the second operation was done for the localized residual dissecting aneurysm in the proximal descending thoracic aorta. The aneurysm was excised, and the entry was closed with Dacron patch using the previously placed axillo-femoral bypass as a technique for preventing distal ischemia. He was recovered uneventfully and was discharged in a good condition.
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PMID:[A successful case of two-staged operation for Stanford type B acute dissecting aneurysm complicated with total occlusion of the distal abdominal aorta]. 793 41

We here present 4 cases with dissecting aneurysm (DA) of the intracranial vertebral artery, who were followed up by repeat cerebral angiography and MRI. The patients consisted of 2 males and 2 females, and the mean age was 43 years. Two cases were associated with polyarteritis nodosa (PN) and hypertension, respectively. Three of the cases developed subarachnoid haemorrhage (SAH), while the other one suffered from lateral medullary syndrome. In cerebral angiography, "pearl and string" signs were revealed in all cases, while a "double lumen" indicating a true diagnostic sign of DA was demonstrated in only one case. Repeat angiography showed that a bleb formation with a bulging of the aneurysmal sac was seen in 2 cases, and an irregularity of the wall in one case. On the other hand in one case, the ectatic part shrank, while the stenotic part was restored. In magnetic resonance imaging (MRI), a hyperintensity mass on T 1-weighted image (T 1-WI) adjacent to flow void suggesting either an intramural haematoma or a linear shape hyperintensity on T 1-WI were demonstrated in 3 cases. In the follow up MRI done in 2 cases, a serial change in the intensity from iso-intensity to hyperintensity on T 1-WI was observed in one case suggesting intramural haemorrhage, while an enlargement of the ectasic flow void was seen in the other case. Three of 4 cases were operated on by trapping of the aneurysms. One, who had systemic vascular diseases due to PN, and repeat angiography showed a regression of the aneurysm, was conservatively treated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Repeat angiography and magnetic resonance imaging (MRI) of dissecting aneurysms of the intracranial vertebral artery. Report of four cases. 851 7

The incidence of intracranial dissecting aneurysms is lower than that of berry aneurysms. Following the recent spread of the use of cerebral angiography, however, the number of patients identified as having this type of aneurysm has been increasing. In a majority of cases of intracranial dissecting aneurysms, the aneurysm afflicted the vertebral and basilar arteries. After these, the internal carotid artery and the middle cerebral artery are the next most frequently affected. It is very rare that this type of aneurysm develops in the anterior cerebral artery. According to our search of the literature, only 17 cases of dissecting aneurysm of the anterior cerebral artery have been reported to date (including the case to be presented here). The case we recently encountered was that of a 52-year-old male. On October 25, 1994, the man suddenly developed a headache and strong paresis of the left leg while performing clerical work. The plain head CT, taken next day, revealed low density in the area supplied by the right anterior cerebral artery. An angiogram taken 6 days after onset disclosed characteristic signs of dissecting aneurysm (i.e., double lumen, etc.) at the A2 segment of the right anterior cerebral artery, as well as the presence of non-ruptured berry aneurysms at the bifurcation of the right middle cerebral artery. The non-ruptured berry aneurysms were treated by neck clipping, while the dissecting aneurysms were treated conservatively. The patient was discharged on March 21, 1995, without needing any assistance to walk. We analyzed the 17 reported cases of dissecting aneurysms of the anterior cerebral artery. The cause of this aneurysm was often hypertension, and only 3 of the 17 cases were rated as being idiopathic cases. The site of this aneurysm was often the pericallosal artery (segments A2, A3, etc.). Of the 17 patients, 11 were middle-aged or elderly (over 40). The male-to-female ratio was 13: 4, indicating a predominance of males. The incidence did not differ significantly between the right and left hemispheres. The number of ischemic cases was more than double that of hemorrhagic cases. Most ischemic cases had a good prognosis, even when treated conservatively. All 3 patients with the hemorrhagic type, who were treated conservatively, died.
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PMID:[A case of anterior cerebral artery dissecting aneurysm]. 855 72

This is a case report of a patient with unruptured dissecting aneurysm in the vertebral artery that bled after being treated by proximal clipping. A 53-year-old male was admitted to our hospital due to transient right hemiparesis which occurred 20 days prior to his admission. He had been medicated for hypertension for the previous 33 years. CT scan and MRI showed lacunar infarction in the left corona radiata, and an aneurysm was accompanied with clot in the prepontine cistern. Angiography revealed a dissecting aneurysm in the right intracranial vertebral artery. His right hemiparesis was derived from infarction in the left corona radiata. It was likely that the dissecting aneurysm might rupture in the future. Proximal clip ping was performed to prevent rupture of the aneurysm. After clipping of the right vertebral artery distal to the PICA, the wall of the aneurysm appeared to be drawn toward the clip blades and to be tensed by the blades. Four hours after the operation, he complained of severe headache, and experienced a sudden loss of consciousness and the immediate development of a deep comatose state. CT scan disclosed massive SAH in the right cerebellopontine and basal cistern. Repeat angiography demonstrated that the aneurysm was not visualized and the right vertebral artery distal to the aneurysms was opacified through the left vertebral artery. Ventricular drainage was performed, but the patient died on the 20th day after bleeding. It was suspected that the aneurysmal clip might have produced shear force on the weak adventitia of the dissecting aneurysms and that the intra-aneurysmal pressure might have increased because of blood back-flow via the contralateral vertebral artery after the proximal clipping.
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PMID:[Bleeding from unruptured dissecting aneurysm in the vertebral artery after proximal clipping]. 892 23

A case with intracerebral hemorrhage secondary to dissecting aneurysm of the anterior cerebral artery was reported. A 36-year-old male, known to have hypertension, developed somnolence and paresis of the left leg while skiing. There was no evidence of trauma. A plain head CT on admission revealed a high density in the right frontoparietal lobe. Three days after the admission CT revealed low density in the area supplied by the right anterior cerebral artery. An angiogram disclosed a double lumen, suggesting a pathognomonic sign of dissecting aneurysm at the A2 segment of the anterior cerebral artery. In the literature, 18 cases of dissecting aneurysm of the anterior cerebral artery were reported including this case. Eleven of the 17 cases were idiopathic, and 8 of the 11 cases had hypertension. We briefly discussed the relationship between the etiology of dissecting aneurysm and hypertension. Cerebral dissecting aneurysm is rare cause of intracerebral hemorrhage. It should be considered in diagnosis when young individuals develop intracerebral hemorrhage.
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PMID:[Intracerebral hemorrhage secondary to dissecting aneurysm of the anterior cerebral artery]. 895 98

Hypertension is observed in three-fourths of the patients in the acute phase of a cerebral infarction. Treatment of an elevated blood pressure in the acute phase of a cerebral infarction is discouraged for the following arguments: In most instances the elevated blood pressure decreases spontaneously in the first few days after the infarction and stabilisation of the blood pressure is usually seen within 4 to 7 days. The elevated blood pressure in the acute phase of the cerebral infarction may be considered a favourable adaptation mechanism aimed at maintaining cerebral perfusion in the region surrounding the infarction. As a consequence lowering of the elevated blood pressure may be harmful because it can lead to expansion of the infarction. No controlled prospective studies to determine if treatment of hypertension in the acute phase of a cerebral infarction might be of benefit have been performed. There are, however, several case reports showing that treatment of an elevated blood pressure in the acute phase of a cerebral infarction is associated with dramatic progression of the neurological deficit. Exceptions can be made for situations where diastolic blood is repeatedly higher than 130-140 mmHg or where there are concomitant cardiovascular diseases, such as myocardial infarction, heart failure or a dissecting aneurysm requiring immediate antihypertensive treatment.
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PMID:[Hypertension in the acute phase of cerebral infarction; not always to be treated]. 954 60

Mortality in poultry due to aortic rupture is characterized by sudden death. The condition is seen in fast-growing male turkeys but has also been described in chickens, ostriches, and waterfowl. Losses in affected flocks usually only reach 1-2%. Post-mortem examination shows a large blood clot in the abdominal cavity subsequent to a dissecting aneurysm. Fragmentation of elastic fibres and degenerative changes of smooth muscle cells are seen in the region of the rupture. Intimal sclerotic plaques are present adjacent to the site of rupture. Copper deficiency, hypertension, hormonal influences, diet, lathyrism, zinc deficiency, pharmaceuticals, and parasites are precipitating factors for aortic rupture. Field studies suggest that favourable results are obtained with reserpine and copper as treatment for ruptured aorta.
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PMID:[Aortic rupture in poultry: a review]. 1023 19

We report a patient with a dissecting aortic aneurysm associated with polymyalgia rheumatica (PMR). The patient is a 55-year-old Japanese man without a history of hypertension, diabetes mellitus and syphilis. He was admitted to an emergency hospital because of severe back pain, and was diagnosed as having a dissecting aneurysm of the descending aorta. After the admission, he began to notice severe muscle pain in his bilateral shoulder. Although his back pain gradually improved, his muscle pain progressively worsened, and his lower extremities were also involved. Then, he was introduced to our hospital. On neurological examination, he was alert and oriented. His cranial nerves were all intact. There was no muscle weakness nor sensory disturbance. Laboratory studies revealed that his erhythrocyte sedimentation rate was extremely high without elevation of the serum level of creatine phoshpokinase, rheumatoid factors and c-reactive protein. He was diagnosed as having PMR, and oral administration of prednisolone++ was started. Within several days, his muscle pain dramatically disappeared. As is known, there is a close relationship between PMR and temporal arteritis of giant cell arteritis. In general, PMR is a benign disease and responds well to steroid therapy, and prevalence of the giant cell arteritis is low in Japanese people. However, it should be kept in mind that the dissecting aneurysm is a relevant, severe complication of PMR because arteritis can be latently present in PMR.
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PMID:[The dissecting aortic aneurysm associated with polymyalgia rheumatica: a case report]. 1065 1

An 83-year-old woman presented with left flank pain and high grade fever. After left ureteral catheterization and intensive chemotherapy with hemoperfusion, surgical exploration revealed the lower pole branches of the renal vessels were obstructing the ureteropelvic junction (UPJ), and dissection of the vessels released the obstruction. An 82-year-old man presented with right flank pain. Angiography demonstrated UPJ obstruction caused by the lower pole branch of the renal artery. Arterial dissection with dismembered pyeloplasty resulted in improvement of obstruction. In both cases, the patients had a long history of hypertension with mild to severe arteriosclerosis. Arteriosclerosis associated with fixation of the UPJ, may be one of the important factors leading to progressive hydronephrosis in geriatric patients.
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PMID:Geriatric ureteropelvic junction obstruction: the possible role of an arteriosclerotic lower pole branch of renal artery: report of two cases. 1076 3

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.
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PMID:Pathology of a dissecting intracranial aneurysm. 1093 47


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