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

Myelopathy is a rare central nervous system manifestation in systemic lupus erythematosus (SLE). We present a case of SLE, who developed motor paralytic bladder and various other neurological abnormalities. A 29-year-old female with SLE was admitted to our hospital because of complete dysuria without any troubles on defecation. Accelerated hypertension had been noticed 2 weeks before the admission. Physical examinations revealed that she had muscle weakness in right brachial biceps, bilateral carpal extensor and flexor, and flexor muscles of bilateral lower extremities. Slight sensory disturbance was present on her soles. Bilateral Chaddok and Babinski's signs were positive. Electromyographic studies including nerve conduction velocities of her limbs were normal, however, neurogenic discharges were observed in anal sphincter muscles. Cystometry demonstrated atonic bladder, but any pathological findings such as lupus cystitis and interstitial cystitis were not observed in the biopsied specimens from her bladder. Antibodies to single-stranded DNA, U1 RNP, Sm and SS-A/Ro were positive in her serum, and lupus anticoagulant and anticardiolipin antibodies (IgG) were also detected. In her cerebral spinal fluid (CSF), elevated protein level and albuminocytologic dissociation were recognized, while glucose level was low. Magnetic resonance imaging (MRI) study detected high signal intensities in the inner part of medulla oblongata and in the spinal cord at second lumbar spine level. After two courses of methyl-prednisolone pulse therapy, the patient's neurological symptoms including dysuria had completely recovered and abnormal findings previously observed on MRI had also disappeared. After 7 months of the episode, she became normotensive. The proteins and glucose levels in her CSF had gradually returned to normal. Among patients with SLE, correlations of antiphospholipid antibodies with myelitis/myelopathy or accelerated hypertension have been reported. Therefore, possible roles of antiphospholipid antibodies were considered in the pathogenesis of neurologic abnormalities observed in our patient. In addition, low glucose level in CSF might be a good indicator for the diagnosis of lupus-associated myelopathy.
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PMID:[A case of systemic lupus erythematosus with various central and peripheral neurological disorders presenting with motor paralytic bladder as a major manifestation]. 859 61

Clinical data, MR-scans, time-dose fractionation schemes and neuropathologic findings of two cases of delayed radiation myelopathy (DRM), are presented. Both patients, a 72-year-old diabetic woman with cervical lymphnode metastasis from a squamous cell carcinoma and a 46-year-old woman with tonsillar carcinoma, developed paraparesis followed by quadriplegia, at 7 and at 10 months following radiation. The spinal cord received 46 and 49 Gy. (Fraction dose 2.25 Gy and 2.0 Gy, 4 times/week). Serial MR-scans showed spinal cord enlargement and focally increased signal intensity (T1-gd). The second patient survived and stabilized following therapy with coumarins. The first patient died 13 months after radiotherapy. At autopsy necrosis, local calcium deposits, lipid macrophages and swollen astrocytes were observed in the white matter. There was slight hyalinosis of the intramedullary vessel walls. We conclude that serial MRI may be helpful to distinguish DRM from other causes of spinal cord injury. DRM may occur at a total dose less than 50 Gy. Additional risk factors (diabetes, hypertension), and fraction doses above 2 Gy contribute to the development of DRM.
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PMID:Delayed radiation myelopathy: serial MR-imaging and pathology. 883 1

Two patients with long-standing tetraplegia after spinal cord injury developed reflex penile erection in the operation theatre. One had not received any anaesthesia, and penile erection occurred after introduction of the cystoscope into the urethra, and also autonomic dysreflexia. Intravenous salbutamol, in a dose of 10 micrograms, produced immediate and persistent penile detumescence and salbutamol-induced fall in blood pressure was of therapeutic value. In the second patient, penile erection occurred during general anaesthesia prior to cystoscopy. Immediate and persistent penile detumescence was achieved with intravenous salbutamol 20 micrograms. There was transient fall of blood pressure which responded to intravenous infusion of 0.9% sodium chloride. Salbutamol-induced fall in blood pressure is of therapeutic value in those spinal cord injury patients who develop, in addition to penile erection, autonomic dysreflexia precipitated by urethral instrumentation, or bladder distension with the irrigating fluid. Intravenous salbutamol is preferable to intra-cavernosal phenylephrine, noradrenaline, metaraminol, and epinephrine, or intravenous ephedrine which are contraindicated in patients with hypertension.
Spinal Cord 1996 Nov
PMID:Intravenous salbutamol treatment for penile erection arising during cystoscopy of cervical spinal cord injury patients. 891 68

We report a 69-year-old woman who developed serious hydrocephalus after cervical laminoplasty for ossification of the posterior longitudinal ligament. The patient presented with approximately 50% spinal canal compromise pertaining to ossified lesion at C5 and C6 levels and subsequently underwent a C3-C7 open-door laminoplasty, followed by uneventful neurological recovery until 2 weeks postoperatively. Despite a favourable postoperative course, she presented with serious symptoms and signs of intracranial hypertension about 3 weeks after surgery. Computed tomography demonstrated the appearance of marked hydrocephalus, with no explainable cause. A ventriculoperitoneal shunt followed by removal of subdural fluid in the suboccipital fossa resulted in resolution of the clinical symptoms and of the hydrocephalus. It is important to be aware of the very rare occurrence of such intracranial neurological compromise after a cervical laminoplasty operation for long-standing ossification of the posterior longitudinal ligament.
Spinal Cord 1996 Nov
PMID:Development of hydrocephalus after cervical laminoplasty for ossification of the posterior longitudinal ligament: case report. 891 70

In previous articles on the Stockholm Spinal Cord Injury Study (SSCIS), we have reported the frequent occurrence of medical problems in a near-total regional SCI population comprising 353 subject. This present study further investigates health-related issues in this SCI population, by a level-of-living survey that has been used annually on 8000-14,000 Swedes since 1974. The health-focused version of this survey was used for data collection in those 326 subjects in the SSCIS who were residents of the Greater Stockholm area. Subjects of the SSCIS living on the island of Gotland were excluded because they represented a sociodemographically different (rural) population. The normative material consisted of 1978 interviews of residents of the Greater Stockholm area, provided by the Swedish Bureau of Statistics. Results show a higher utilisation of health care resources among SCI subjects, shown by higher rates of long-term sick leave and sick pension, and more treatment as inpatients, emergency room attendees, and outpatients. Pain, bladder problems, and psychological symptoms are more commonly reported by SCI subjects. Medications such as antibiotics, analgesics, sedatives, hypnotics and laxatives are used more frequently in the SCI group. In contrast, no statistically significant differences were found as regards reported prevalence of diseases other than SCI, including diabetes, hypertension and cardiac disease. The results thus verify the impression from our previous studies of a clearly increased morbidity among these SCI subjects. The increased morbidity seems to be accounted for by the SCI itself, or conditions directly caused by it.
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PMID:The Stockholm Spinal Cord Injury Study. 3. Health-related issues of the Swedish annual level-of-living survey in SCI subjects and controls. 892 13

The best treatment for deep-seated dural arteriovenous malformations (AVMs) remains controversial. Therapeutic options include transarterial and transvenous embolization, surgical excision of the dural nidus, ligation of draining veins, and stereotactically guided radiation treatment. The authors report on their experience with the application and technique of skull base surgical approaches for deep-seated dural AVMs. Their series includes six patients who were surgically treated for five tentorial dural AVMs and one inferior petrosal sinus dural AVM between 1991 and 1995. Three patients presented with progressive brainstem dysfunction, one had progressive myelopathy, and two suffered subarachnoid hemorrhage. Venous hypertension caused progressive neurological deterioration in four patients and ruptured venous aneurysms caused hemorrhage in two patients. Four of the five tentorial dural AVMs received bilateral arterial supply from the internal carotid arteries and external carotid arteries (ECAs). The dural AVM of the inferior petrosal sinus was fed from both vertebral arteries and ECAs. In this series, all dural AVMs drained into deep cerebral veins. Intra- and postoperative angiographic studies were used to document complete obliteration in each case. After surgery, three patients developed transient, delayed (24-72 hours) neurological worsening. One month postsurgery, all six patients showed improvement from their preoperative neurological function. Surgical resection of these deep-seated dural AVMs was accomplished by eliminating the arterial supply rather than ligating the draining veins to avoid aggravating the underlying venous hypertension. This study demonstrates an important role for skull base surgical approaches in the management of patients with deep-seated dural AVMs that have hemorrhaged, are not obliterated by embolization, and for which stereotactically guided radiation therapy is an unsuitable option.
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PMID:Surgical management of deep-seated dural arteriovenous malformations. 925 82

As alluded to at the onset, our purpose is to provide a periodic reminder about autonomic dysreflexia/hyperreflexia (AD). Some historical background was offered since so much of the recent literature has been obtained from Medline which started in 1966. There were a number of early pioneers who first labored with AD. Kewalramani, in his fine paper, found various names for AD in the literature: sympathetic hyperreflexia, paroxysmal hypertension, spinal poikilopiesis, autonomic spasticity, paroxysmal hyperactive autonomic reflexes and paroxysmal neurogenic hypertension. Why not use only one term for this life threatening syndrome: autonomic dysreflexia/hyperreflexia.
J Spinal Cord Med 1997 Jul
PMID:Autonomic dysreflexia/hyperreflexia. 926 82

Interruption of autonomic pathways by spinal cord injury (SCI) causes dysfunctional autonomic dysreflexia (AD), which was first described in 1917, still remains unrecognized by those in the medical profession not involved in SCI care. Autonomic dysreflexia is a syndrome generally manifest by cardiovascular symptoms and characterized by paroxysmal hypertension. These symptoms appear in patients with spinal cord injury above the sympathetic outflow from the spinal cord (T6). Since patients with high level SCI are usually hypotensive, the high blood pressures that develop during AD represent pressure changes of a magnitude that can cause cerebrovascular accidents and death of the subject. We discuss the therapeutic interventions that abate and curtail the symptoms and prevent the catastrophic sequelae of autonomic dysreflexia.
J Spinal Cord Med 1997 Jul
PMID:Autonomic dysreflexia: pharmacological management of hypertensive crises in spinal cord injured patients. 926 83

Autonomic dysreflexia (AD) is a characteristic syndrome that occurs in spinal cord injury (SCI) patients with lesions above the sympathetic outflow at T6 and rarely in those with lesions below T10. Symptoms are initiated by noxious stimuli below the level of injury which result in massive sympathetic discharges from the isolated cord. These produce what may be called a sympathetic storm manifest by severe life threatening hypertension. Anesthesiologists and surgeons dealing with SCI patients must know how to recognize this syndrome, how to prevent its occurrence and how to manage it aggressively. Choice of anesthesia is frequently difficult and, in particular, it may be difficult to decide which type of anesthesia is best for patients susceptible to the syndrome. Therefore, we have conducted a retrospective study of SCI patients in the Department of Veterans Affairs Medical Center, Long Beach, California, where the Spinal Cord Injury Service is one of the largest in the country.
J Spinal Cord Med 1997 Jul
PMID:Surgical aspects of autonomic dysreflexia. 926 84

Glucose intolerance and dyslipidaemias have been reported among paraplegics and tetraplegics. In this study we determined the lipid profiles and the glucose tolerance in a group of 48 persons with spinal cord lesions who had been rehabilitated in our Department of Physical Medicine and Rehabilitation. This non-randomised, descriptive study was conducted as part of the annual medical follow-up of these individuals. Hypertension was observed in only 6% of the subjects. Fasting hyperglycemia was observed in 19% and glucose intolerance in 23% of the subjects. Total cholesterol was abnormal in 2%, but 58% had low levels of high density lipoprotein (HDL). 10% of the subjects had raised low density lipoprotein (LDL) levels. The cardioprotective HDL fraction may remain very low even while the total cholesterol level is within normal limits, and unless a lipid profile estimation is done, this group of individuals who are at cardiovascular risk may remain undetected. We conclude that glucose intolerance and dyslipidaemias are common among paraplegic and tetraplegic individuals, and these metabolic derangements may contribute to increased cardiovascular morbidity.
Spinal Cord 1998 Apr
PMID:Glucose intolerance and dyslipidaemias in persons with paraplegia and tetraplegia in south India. 958 21


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