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

Isotope cisternography was performed and ventricular system size was evaluated on serial computerized tomography scans in 57 patients with plateau waves in their continuous intracranial pressure recordings. The patients were assigned to three groups based on the presence or absence of communicating hydrocephalus and their intracranial pressure level: the first group comprised 23 patients with high intracranial pressure and without hydrocephalus, resulting from supratentorial brain tumor, benign intracranial hypertension and superior sagittal sinus thrombosis; the second group included 22 patients with either high intracranial pressure or communicating hydrocephalus, resulting from intracranial aneurysmal rupture: and the third group was composed of 12 patients with normal intracranial pressure and communicating hydrocephalus, resulting from intracranial aneurysmal rupture. Plateau waves in the first group patients were characterized as large plateau like formations recurring at varying intervals, with a height of 50-100 mmHg and a duration of 10 to 30 minutes. Plateau waves in the second group patients had a height of 20 to 60 mmHg and a duration of 3 to 15 minutes. The waves in the second group patients were smaller in amplitude and shorter in duration as compared with the waves in the first group patients. Plateau waves in the third group patients had an amplitude of 15 to 40 mm Hg and a duration of 3 to 10 minutes. They were the smallest in amplitude and the shortest in duration as compared with the plateau waves seen in the first and the second group patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Note on the mechanism of producing the plateau waves]. 633 1

Brain tumors are, after leukemias, the most frequent fatal neoplasms of infancy. The clinical features and symptoms are often markedly different from those observed in the adult forms, according to the peculiar anatomy and behaviour of the child. Persistent headache, vomiting, astenia , behavioral alterations may be the precocious findings. Later, some more specific and suggestive signs such as strabismus, dyplopia , fast head size increase, funduscopic alterations, ataxia, paresis and nystagmus may be observed. On their appearance a prompt diagnostic work-up should be performed. The tumors of the posterior fossa (cerebellar astrocytoma and medulloblastoma, brainstem glyoma , hependimoma in decreasing order of frequency) generally cause precocious symptoms because of the small dimension of the subtentorial space; the presence in this region of several fundamental nuclei and pathways may explain how also small tumors may cause severe deficits. Supratentorial tumors (astrocytoma, malignant glyoma , hependimoma , craniofaringioma ) often show a more prolonged latency and may begin with signs of endocranial hypertension, seizures, or sometimes with hormonal troubles according to the involved anatomic structures. Hypothalamic astrocytoma is responsible of an extreme weight loss as far as to a cachetic status, due to the hyperincretion of GH. Finally, plexus papilloma, dermoid, optic nerve glyoma , oligodendroglyoma , germinoma, teratoma are responsible of a small number of child brain tumors, with different localization and symptomatology.
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PMID:[Clinical course of brain tumors in childhood]. 673 95

To test the hypothesis that preoperative head computed tomography scans could be used to predict the likelihood that a patient with a supratentorial brain tumor would develop intracranial hypertension during surgery before the cranium was opened, intraoperative intracranial pressure and blood pressure records of 60 patients undergoing craniotomy were compared with the appearance of their preoperative computed tomography scans. The scans were interpreted by a neuroradiologist who was unaware of the clinical events in each case. A positive correlation was found between the amount of preoperative brain edema observed surrounding tumors (on an arbitrary 0 to 3 + scale) and subsequent increases in intracranial pressure greater than base line values. No such correlation could be found with regard to tumor size, shift of midline structures, or effacement of the lateral ventricles. When preoperative brain edema seen on computed tomography scan was taken into consideration, increases in intracranial pressure during craniotomy also correlated with simultaneous increases in blood pressure. It is concluded that patients with large amounts of preoperative brain edema surrounding supratentorial tumors should be considered at risk for developing intraoperative intracranial hypertension and may benefit from preoperative insertion of an intracranial pressure monitor before general anesthesia is induced.
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PMID:Intracranial hypertension during surgery for supratentorial tumor: correlation with preoperative computed tomography scans. 719 67

A case of multiple focal nodular hyperplasia (FNH) of the liver associated with noncirrhotic portal hypertension and later complicated by pulmonary arterial hypertension leading to death from right heart failure is reported. In retrospect, the portal hypertension diagnosed in early life was most likely due to a congenital hypoplasia of portal vein branches and multiple FNH, a hyperplastic response of the liver parenchyma in association with anomalies of hepatic arterial branches as found within the lesions. This case may represent a form of multiple FNH syndrome restricted to the liver, because neither extrahepatic vascular malformation nor brain tumor was identified at autopsy. The FNH lesions had considerably expanded over the years, and the severe sinusoidal congestion due to chronic right-sided heart failure with subsequent prolonged parenchymal exposure to blood-borne hepatotrophic factors is a likely explanation for both the massive enlargement of FNH lesions and the nodular regenerative hyperplasia observed in the intervening parenchyma.
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PMID:Nodular transformation of the liver associated with portal and pulmonary arterial hypertension. 822 77

The brain tissue distribution of etoposide has been investigated in 9L gliosarcoma-bearing rats with or without hypertension induced by angiotensin II (AT II). The rat brain tumor models were divided into the following two groups according to etoposide administration route: intracarotid injection (IC) group and intracarotid injection with hypertension induced by AT II (IHIC) group. Ten mg/kg of etoposide was given, and 30 min and 2, 4, 8, and 24 hr later the rats were sacrificed. The drug concentrations in the serum, tumor, and normal brain tissue were analyzed by high-pressure liquid chromatography. The etoposide concentration in the serum, tumor, and normal brain tissue peaked at 30 min in both groups. The serum concentration was similar between the two groups. The etoposide concentration in the tumor was at least 2.2 times higher in the IHIC group than in the IC group at 30 min and 2 hr. The area under drug concentration curve (AUC) in the tumor in the IHIC group was about 2.2 times higher than that in the IC group. The etoposide concentration in the normal brain on the drug injection side changed only slightly from 0.5 hr to 4 hr and was about 3 times higher in the IHIC group than in the IC group. The etoposide concentration in the contralateral normal brain was very low in both groups at 30 min and disappeared thereafter. Intracarotid injection of anticancer drugs with AT II-induced hypertension further increases the drug concentration and AUC in the tumor compared with intracarotid injection alone and can be useful in treatment of malignant brain tumors.
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PMID:Analysis and distribution of etoposide in rat brain tumor model: intracarotid versus intracarotid with angiotensin II-induced hypertension. 848 52

A study of headache in a homogeneously ascertained population of 181 subjects suffering from neurofibromatosis type 1 is described. All subjects underwent a diagnostic protocol including imaging studies (for subjects over 5 years old up until 1992). Headache data were collected by means of a questionnaire. Headache was present in 55 of 181 subjects (25 males). Overall headache frequency was 30%, which is not significantly different from the frequency of headache reported in the general population. Headache was primary in 52 cases (5 migraine and 47 tension-type) and secondary to obstructive hydrocephalus with brain tumor-induced intracranial hypertension in 3 with a tension-type pattern. It was concluded that headache is not a specific feature of neurofibromatosis type 1, it is not significantly related to central nervous system abnormalities, and in itself, it is not an indication for neuroradiological examination.
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PMID:Headache in patients with neurofibromatosis type 1. 866 29

Differential diagnosis of dementing diseases is very important to rule in the so-called treatable dementia. The new DSM-IV criteria for dementia include memory disturbances and one or more of aphasia, apraxia, or frontal lobe dysfunctions as essentials. Alzheimer disease requires, in addition, slowly progressive course and ruling out other brain or systemic diseases. Vascular dementia requires focal neurological or neuroimaging signs. Other diseases which cause dementia include chronic subdural hematoma, infection and brain tumor. CT or MRI can readily diagnose them if suspected and they may be treated. Systemic diseases associated with treatable dementia include electrolyte disturbances, hypothyroidism, vitamin deficiency, alcohol or drug intoxication, syphilis and HIV infection. Prevention of dementia seems to be the future problem as we could prevent cerebrovascular diseases by treating hypertension.
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PMID:[Clinical aspects of dementia]. 875 26

A 28-year-old male presented with a low grade fever, decreased activity, left hemiparesis and signs of intracranial hypertension. CT showed a moderate hydrocephalus and a large irregular mass in the right temporoparietal region with garland-like enhancement after injection of the contract medium. These findings suggested a malignant brain tumor. MR images demonstrated a mass with low-iso signal intensity on T1 weighted image and low-iso-high mixed intensity on T2, which is like a mosaic pattern. Multiple cerebrospinal fluid space seedings including the wall of the lateral ventricle, the surface of the cerebellum and pons, and the cervical spinal cord were clearly delineated on MR images after Gd-DTPA injection. The large mass was totally removed by craniotomy after ventricle drainage for hydrocephalus. Microscopic examinations showed dense fibrous connective tissue with infiltration of Langhans' giant cells, lymphocytes and fibroblasts around the necrotic centers. These hard components may have been responsible for the low signal intensity on T2-MR images. Many Candida elements were clearly shown with the periodic acid Schiff stain. The diagnosis was that the lesion was an intraparenchymal granuloma due to Candida infection. The patient died on the 8th postoperative day because of brain stem malfunction. Intracranial fungal infection rarely produces a granuloma in the central nervous system. Though it is difficult to diagnose a large irregular mass in the brain, MR images, especially T2 weighted images are useful for the diagnosis of fungal granuloma.
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PMID:[Intracranial fungal granuloma with CSF space dissemination: a case report]. 893 95

These cases demonstrate a few of the presentations that may occur with new onset oncologic problems. While the transport phase of these children's care was not extraordinary, the development and management of the clinical issues might have been influenced by earlier interventions. Would the outcome of Case 1 have been different if the abnormal hematologic parameters demonstrated on the preoperative laboratory results had been further investigated? Would the institution of cerebral resuscitative measures before and during transport have offered this child a better chance of survival? Would the involvement of a specialized pediatric team earlier in the process have addressed some of those issues and would it have made a difference? Should the patient in case two have had cerebral resuscitative measures instituted at the referring hospital or during transport? In hindsight, this clearly would not have been useful or beneficial to the patient. But what if the initial CT interpretation of a brain tumor and increased intracranial pressure with ventricular ablation and midline shift had been correct? Should the transport team have suggested or instituted a different level of therapy with the information that was available at the time of transport? The patient in Case 3 had a dramatic presentation of his ALL. Were there signs and symptoms that should have alerted the referring hospital, transport command physician or transport team to the likely deterioration of that patient? If this patient had presented to a hospital a further distance away, would the impending cardiovascular collapse and respiratory failure have been anticipated or occurred during the transport? Would or should the mode of transport or team configuration have been altered? If this patient had deteriorated during the transport, would the transport team have had the skills to manage this potentially difficult airway? Should the patient in Case 4 have had antihypertensive medication started at the referring hospital or during the transport process? What are the guidelines for antihypertensive intervention in this situation? If antihypertensive therapy were instituted by the transport team, should this have affected time or mode of transport, or was it more prudent not to rock the boat by instituting interventional therapy? Is hypertension a different issue with a liver mass, as suspected at the time of referral, or with a nephrogenic tumor? These cases afford us the ability to review several presentations of oncologic emergencies. The questions above are but a few of the potential areas of discussion that can arise from these cases. We should use these cases as an opportunity to review and refresh our transport teams on the many faces of oncology and potential pitfalls in the care of those patients.
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PMID:Oncology and transport. Beware of the presentation and anticipate the clinical course. 898

We report a rare case of a second primary brain tumor following esophageal cancer. A 56-year old Japanese man underwent a transhiatal esophagectomy for esophageal carcinoma. Two years after the operation, signs of increased intracranial hypertension including headache, nausea and left limb ataxia were observed. The tumor was totally removed by a suboccipital craniectomy, and the histological diagnosis was hemangioblastoma. The post-operative course was uneventful and the patient is still alive without any signs of recurrence. It is important to make a precise strategy for the second primary tumor.
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PMID:Esophageal cancer and second primary brain tumor. 968 23


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