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

A case of cerebral oedema developed during an apparently common attempted suicide with valpromide is reported. The most conspicuous biochemical abnormality was hyperammonaemia. The oedema proved refractory to the standard medical treatment of intracranial hypertension, and decompressive craniectomy was performed with only minor sequelae. The cerebral oedema cum hyperammonaemia syndrome led to the discovery, in this hitherto asymptomatic adult subject, of a 50 per cent deficiency in type a carbamyl phosphate synthetase liver activity. By completing such a deficiency, valproate may produce an extremely serious syndrome resembling the neonatal encephalopathy due to complete enzyme deficiencies in the urea cycle. All valpromide or valproate intoxications probably are cerebral oedemas with hyperammonaemia akin ti Reye's syndrome. All accidents of this type occurring during treatment or poisoning with valproate should be investigated for urea cycle enzyme abnormalities.
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PMID:[Cerebral edema with hyperammonemia in valpromide poisoning. Manifestation in an adult, of a partial deficit in type I carbamylphosphate synthetase]. 297 63

Reye's syndrome (RS) has been defined by the CDC as an acute non-inflammatory encephalopathy and hepatopathy, with no reasonable explanation for the cerebral and hepatic abnormalities. The diagnosis of RS is made by a constellation of clinical and laboratory features, none of which are pathognomonic. The demonstration of a fatty infiltration on liver biopsy is not really specific. On the other hand, the mitochondrial ultrastructural abnormalities appear to be characteristic of RS. Cerebral edema with intracranial hypertension represents the most immediate threat to life, the cause of the encephalopathy being unknown. The treatment of RS consists in perfusion of hypertonic glucose solution and management of intracranial hypertension. Grade I RS should be recognized early and treated with intravenous glucose. A number of metabolic disorders may yield a clinical picture resembling RS. These include disturbances of organic acid metabolism, urea cycle defects, and disorders of carbohydrate metabolism. The pathogenesis of RS is a mitochondrial insult induced by different viruses, drugs, exogenous toxins, and genetic factors. In the USA, pilot studies showed that a majority of RS cases may be attributable to salicylate use. In France, RS remains unfrequent although no precise epidemiological data are available. An epidemiological study appears therefore necessary for a better understanding of this mysterious syndrome. There is a need for a biological marker of the mitochondrial injury.
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PMID:[Reye's syndrome. A current entity which remains enigmatic]. 305 99

Two cases of subcortical arteriosclerotic encephalopathy (Binswanger's disease) are reported. The two patients lacked a clinical history of hypertension, relevant pathogenetic factor in the development of the small and medium size cerebral arteries atherosclerosis, which is the main pathologic finding of the disease. The two subjects clinically showed a marked intellectual deterioration, together with mood depression and focal neurological signs, that were an expression of the multifocal neurologic involvement. In both cases CT scans evidentiated a mainly periventricular leucoencephalopathy associated, in the first patient, with small multiple ischemic lesions and, in the second, with a unique hypodense area in the centrum semiovale. A review of the literature on the subjects is proposed, together with an attempt of pathogenetic interpretation of our two cases.
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PMID:[2 cases of Binswanger's disease not associated with arterial hypertension: clinical-instrumental and neuropsychological evaluation]. 305 88

Cerebral microangiopathies based on arteriosclerosis are frequent. In most cases, microangiopathy is the result of long standing hypertension. Other risk factors, however, such as diabetes mellitus or disturbances of fatty metabolism, may also be responsible. The sequels of cerebral microangiopathy can be lacunar infarcts or subcortical arteriosclerotic encephalopathy. Both status lacunaris and subcortical arterioslerotic encephalopathy can result in development of dementia if they last for a long time. Particularly in these disorders, however, it is imperative to carry out preventive measures by influencing the vascular risk factors. Another approach to therapy is offered by influencing the haemorrheological properties of the blood by means of vasoactive preparations.
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PMID:The significance of microcirculatory disturbances in the pathogenesis of vascular dementia. 306 8

Neuropediatric emergencies are reviewed. In particular in this topic the Authors point out the diseases in which an immediate treatment is required. Hypoxic ischemic encephalopathy, acute neonatal metabolic disease, seizures disorders and status epilepticus, meningitis, encephalitis, post viral neurological syndromes, acute hemiplegia, coma, acute endocranial hypertension are discussed with special emphasis on the possible causes and treatment.
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PMID:[Neurologic emergencies in children]. 307 30

Previous reports have described 5-20% prevalence of hyponatremia in extended care facilities, due largely to drugs or inappropriate antidiuretic hormone secretion. In our 400 bed VA extended care facility, 15 men with organic brain syndrome (Alzheimer's, multi-infarct dementia, anoxic encephalopathy or alcoholism) currently receive Isocal via gastrostomy as the sole source of nutrition. We noted intermittent hyponatremia in about half of these patients, and conducted a chart review to investigate the cause. Mean age was 68 yr (range 46-92); tube feeding duration was 3 mo.-3 yr; 266 Na concentrations were obtained from the charts. Simultaneous with these Na analyses, one of three diets prevailed: (A) mixed foods (3-6 g Na/day) orally before gastrostomy; (B) Isocal supplemented with NaCl to give 2 g Na/day; (C) unsupplemented Isocal providing 1 g Na/day. (B) and (C) had been randomly varied by rotating physicians. Serum Na was directly related to Na intake. On (A), Na was within normal range (135-145 mEq/l) in all men. One patient was hyponatremic during diet (B). During (C), eight patients were hyponatremic. Na was less than 135 mEq/l in 40% of all samples during diet (C) and less than 130 mEq/l in 14%. Changing from diet (A) or (B) to diet (C) caused nearly equivalent declines in Na and Cl; K and HCO-3 were unaffected. No hyponatremic patient took drugs known to cause hyponatremia, or had congestive heart failure, hypoalbuminemia, lipemia or fasting hyperglycemia. At the end of the study, four hyponatremic men were changed from (C) to (B); serum Na became normal in all four patients, without edema or hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hyponatremia in tube-fed elderly men. 308 Apr 61

2 cases reports are described of patients with renal artery stenosis who presented with hypertensive encephalopathy, normal blood pressures having been recorded within the previous 6 months while taking oral contraceptives (OCs). A 27-year-old woman, admitted to the hospital following 2 grand mal fits, had suffered from increasing headaches, nausea, and vomiting over the previous month. Her blood pressure had been elevated at 160/110 mmHg 1 week prior to admission but had been normal over previous 11 years while taking OCs (various formulations of combined estrogen and progestogen) which she had stopped taking 2 months previously. She was a nonsmoker. Her blood pressure was controlled with atenolol, nifedipine, and bendrofluazide, and her conscious level returned to normal with no further fits. An intravenous urogram revealed a small left kidney with a delayed nephrogram, and subsequent arteriography showed bilateral medial fibromuscular dysplasia with a narrow stenosis of the left renal artery. Attempted balloon angioplasty was unsuccessful due to arterial spasm. 4 months after presentation she became pregnant. Blood pressure was controlled with methyl dopa during pregnancy which progressed uneventfully to full term. In the 2nd case, a 19-year old girl became confused and suffered a grand mal convulsion. She had complained of headaches over the previous 3 days. Her blood pressure had been normal over the previous 6 months while taking Logynon (phased formulation of ethinylestradiol and levonorgestrel). She was a nonsmoker. On admission to the hospital, she suffered further generalized convulsions. Despite control of her convulsions with intravenous chlormethiazole, her blood pressure rose to 220/140 mmHg, and this was controlled with intravenous hydralazine and propranolol. The following day she was conscious and was changed to oral therapy. A renogram and DMSA scan showed normal sized kidneys, but there was evidence of decreased blood flow to the left kidney with an increased transit time. Renal arteriography showed a stenosis of the left renal artery, typical of intimal fibromuscular dysplasia, which was dilated by balloon angioplasty. Anti-hypertensive medication was withdrawn postoperatively, and her blood pressure has remained well controlled. In both of the cases the onset of hypertension was rapid with encephalopathy being the presenting feature. Hypertensive encephalopathy is well recognized as a presenting feature of renal transplant artery stenosis but not in cases of native renal artery stenosis. 1 of the patients had stopped using OCs 2 months before presentation, suggesting that although there may have been an association between OC use and the development of fibromuscular dysplasia, it could not be implicated in the mode of presentation.
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PMID:Encephalopathy in renovascular hypertension associated with the use of oral contraceptives. 311 27

Numerous studies have shown that longterm oxygen therapy in hypoxaemic patients with chronic airflow obstruction (BPCO) is capable of improving the prognosis and decreasing the risk of cardio-respiratory decompensation; in addition sometimes physical capacity and intellectual capacity is improved. Another result often noted is a reduction in the mean hospital stay which corresponds to an improvement in the quality of life. A PaO2 constantly below 55 mmHg (7.3 kPa) is defined by the majority of authors as a precarious state. At this level even a small change in alveolar ventilation or disturbance of distribution would lead to an important fall in the oxygen content of the arterial blood. The stability of the PaO2 during the weeks of respiratory reeducation with specially controlled medical treatment, as well as the willing consent of the patient and his family, are indispensable conditions for the prescription of OLT. When hypoxaemia is of moderate severity (PaO2 between 50 and 60 mmHg (6.6-8 kPa), prolonged medical treatment (with abstention from tobacco) for at least two months is advised and a study of complementary criteria to further validate the indications for oxygen. Such features would include a worsening of the hypoxaemia during exercise of 30 to 40 watts (PaO2 less than 50 mmHg, 6.6 kPa), an elevated haematocrit (greater than 55%), a rise of the P (A-a)O2 (greater than 30 mmHg or 4 kPa), a nocturnal desaturation even in the absence of apnoea (oxyhaemoglobin saturation (SaO2) of less than 80% for more than 50% of the time asleep). Added to these criteria are the radiological, echographic and clinical signs of the effect of hypoxaemia on the pulmonary circulation. Frank pulmonary arterial hypertension observed in hypoxaemia of moderate severity when the PaO2 is in the region of 55 mmHg and is an argument for the prescription of OLT. Amongst the developing criteria, exacerbations of respiratory encephalopathy, intellectual deterioration, progressive wasting, permanent ventilatory embarrassment with tachypnoea, should be borne in mind as the occasion arises. A schedule of 18 hours per day (without stopping for more than 3 hours) is necessary to obtain an improved survival and places a great demand on patient co-operation and on their environment. A prolonged educational programme is required. To achieve such a schedule the use of portable oxygen may be justified so that patients can lead a normal social life.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Critical study of the indications for long-term oxygen therapy. Chronic obstructive bronchopneumopathies]. 314 Mar 16

Mean arterial pressure and intracranial pressure were measured serially in six infants with intracranial hypertension (intracranial pressure greater than 20 mm Hg), and cerebral perfusion pressure was calculated from their difference. Overall, mean arterial pressure increased with rising intracranial pressure at a mean rate of 0.20 mm Hg/mm Hg. This caused a fall in cerebral perfusion pressure with increasing intracranial pressure at a mean rate of 0.80 mm Hg/mm Hg overall, although cerebral perfusion pressure was well maintained in one infant. Thus the rise in blood pressure was usually insufficient to compensate for the increase in intracranial pressure. In infants with acute encephalopathy vigorous blood pressure support is as important as lowering intracranial pressure.
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PMID:Hypertensive response to raised intracranial pressure in infancy. 323 94

Using noninvasive (echoventriculometry (Echo-VM), REG and invasive (planimetric PEG, graphic recording of the CSF pressure) methods of examination, the authors determined the size of cerebral ventricles and the status of the cerebral hemo- and CSF dynamics in 606 patients with various chronic diseases of the brain (consequences of craniocerebral injury, epilepsy, discirculatory encephalopathy, etc.). According to PEG and Echo-VM findings, two groups of patients were distinguished. In moderate dilatation of cerebral ventricles the most significant finding was an increase in the pulse pressure of the CSF, whereas its mean pressure was normal or slightly elevated. In patients with pronounced hydrocephaly the pulse and mean pressure of the CSF tended to decrease. The progress of hydrocephaly was parallelled by increasing disorders of the cerebral hemodynamics expressed in hindered venous outflow from the cranial cavity and elevated peripheral vascular resistance. Four CSF-related syndromes have been identified (normotension, total CSF hypertension, intraventricular tension, total CSF hypotension) differing in their diagnostic and prognostic significance and in the pathogenesis of disorders of the hemo- and CSF dynamics.
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PMID:[Status of the ventricular system and dynamics of the cerebrospinal fluid changes in chronic brain diseases]. 325 71


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