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

We initiated a prospective study of the dizzy patient to identify key factors on which a directed evaluation could be based. This study used a standardized history, physical examination, and basic laboratory evaluation totalling 66 items to assist collection of relevant clinical information on 125 patients. Diagnosis was based on the emergency physicians' diagnosis. This was modified when necessary based on one month of follow-up using diagnostic criteria adapted from previous studies. The most common disorder was some form of peripheral vestibular disorder, found in 54 patients (43%). These patients were typically vertiginous and were managed successfully as outpatients. Despite correlations with multiple factors, this diagnosis was best predicted by positive Nylen-Barany test with either vertigo, vomiting, or both with 94% specificity and 43% sensitivity. Potentially serious causes were identified, including medication-related, seizure, stroke, transient ischemic attacks, vertebral-basilar insufficiency, hypertension, pericarditis, arrhythmias, and all those requiring hospitalization. The best predictors, either older age, lack of vertigo, or neurologic deficit, could identify 86% of "serious" dizziness with 42% specificity. The following tests were of low yield and may be done in a directed manner based on a brief history: Valsalva, carotid stimulation, Romberg and Quix tests, mental status examination, complete blood count, serum electrolytes, and BUN. Our results do support routine testing of glucose in all patients and monitoring rhythm in patients age 45 and older. Such a directed approach could rapidly classify a significant number of dizzy patients and forego many time- and cost-intensive elements of provocative examination and laboratory testing.
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PMID:A directed approach to the dizzy patient. 272 92

We prospectively studied 34 patients with clinical and radiologic evidence of rostral basilar artery syndrome, a vaso-occlusive disorder, who had uniformly excellent short-term functional recovery, in marked contrast to the classic syndrome. All patients displayed important neurobehavioral disturbances, including an acute confusional state, necessitating medical consultation. The composite group had minimal hypertension, significant arrhythmias in the young, and no history of vertebrobasilar insufficiency. Unsuspected cases of idiopathic orthostatic hypotension, as well as cardiac arrhythmias in the elderly, were discovered. A vascular cause was not considered in 79% of those presenting for emergency evaluation and prevented proper acute diagnostic evaluation in 88%. Recognition of this potentially reversible cerebrovascular syndrome may prevent hazardous diagnostic and therapeutic interventions.
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PMID:Reversible rostral basilar artery syndrome. 333 91

Among fifty-two angiographically examined patients of vertebro-basilar disorder, incidental intracranial aneurysms were found in five cases. These were four males and a female, ages ranging from 42-67 year old. Vertebro-basilar disorders were ischemic origin in three cases and hemorrhage in two cases. Locations of incidental aneurysms were the internal carotid artery, middle cerebral artery, anterior communicating artery and basilar artery. They were multiple in three cases. They were operated on radically, except one case whose status seemed to be untolerable to the operation. Intervals between strokes and operations were 51-81 days. In spite of successful operation, mild to moderate disturbances of consciousness appeared in three cases. In two cases they were subsided in a week, but in one case it persisted for two months. Fortunately, final results in all operative cases were good. These transient deterioration of consciousness level might probably be ascribed to vertebro-basilar insufficiency once subsided but resumed due to the operative affections. Through a small experience of four cases, three points would be discussed to prevent such hazards. 1) Extreme systemic hypotension as well as hypertension should be avoided during operation. 2) GOF might be an anesthesia of choice in such cases. 3) Operation should be favorably waited for more than six months after the ictus.
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PMID:[Unruptured intracranial aneurysms associated with vascular disorder of the vertebro-basilar system: report of five cases]. 344 5

When confronted to an occipito-cervical headache too often cervical etiology is proposed. Several cervical mechanisms are however possible: 1) neuralgic mechanism for the three first cervical segments. Any vertebral or intra-spinal lesion may affect the first three posterior roots; 2) muscular mechanism affecting cranio-cervical muscles: role of posture; spinal unbalance; traumatic or acute rheumatic discovertebral lesion; 3) vascular (arterial) mechanism, much more unfrequent like vertebro-basilar insufficiency. The role of vegetative (sympathetic) system is practically inexistant. So cervicarthrose play no role when there is no arthro-muscular involvement with painful limitation of cervical movements. But the most important causes of posterior cephalalgia are not of cervical intracranial origin: they are tumours of posterior fossa; high blood pressure, and above all tension headache of psychic origin.
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PMID:[Headache of cervical origin. Critical study (author's transl)]. 624 51

CT examination in 100 patients affected by chronic cerebrovascular insufficiency showed a normal picture in 16 cases, while 84 subjects showed different degrees of atrophy, generalised and focal, controlateral or sometime omolateral to the infarct, with differing patterns. The mean age of subjects with normal CT was significantly lower in comparison with patients with definite atrophy. Besides the neurological picture and the time course, the patients' psychiatric status was also assessed: no definite relationship seems to exist between psychiatric disturbances and brain atrophy. Pseudobulbar syndrome was found in 46 cases and many of them showed cortical and mainly ventricular atrophy. This picture was very seldom found in patients with vertebro-basilar insufficiency. Localised cortical atrophy, on the contrary, was often associated with ischaemic stroke. The incidence of predisposing risk factors (hypertension, diabetes mellitus or high lipid levels) was greater in subjects with brain atrophy and older age than in patients with normal CT scan.
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PMID:[CT findings in chronic cerebrovascular insufficiency (author's transl)]. 729 86

Six patients for whom computed tomography revealed a curvilinear calcific mass anterior to their brainstem were evaluated and magnetic resonance imaging and magnetic resonance angiography were performed on each. Magnetic resonance studies confirmed the suspicion of basilar artery dolichoectasia, and demonstrated a partial thrombus in the basilar artery in 1 patient. The patients' clinical features were combined with those of basilar artery dolichoectasia patients reported in the literature (n = 122) who had case histories sufficiently detailed enough to determine each person's mode of clinical presentation. Basilar artery dolichoectasia patients were more often men (95/128, 74%) and had a mean age of 59 +/- 11 years. Of the 128 patients studied, there were cranial nerve compressive signs in 74 (58%), especially facial spasm (29/74, 39%) and trigeminal neuralgia (20/74, 27%); vertebral basilar insufficiency or vertebral basilar stroke or both in 61 (48%); hydrocephalus in 40 (31%); compressive brainstem symptoms and signs that progressed clinically in 31 (24%); and arterial hypertension in 31 (24%). Magnetic resonance imaging and magnetic resonance angiography safely diagnose this interesting arterial abnormality. The modes of clinical presentation of this disorder are reviewed.
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PMID:Basilar artery dolichoectasia. Review of the literature and six patients studied with magnetic resonance angiography. 762 24