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

On the basis of 90 cerebral AVMs, the authors study clinical signs which show the AVM, before a dramatic bleeding. Such clinical signs are: benign subarachnoid hemorrhage or intracranial hypertension and, only for lobar AVMs, migraine, epileptic seizures, progressive neurological deficit. In such cases a misdiagnosis is avoided by CT Scan with contrast. In the second part, the authors show that the AVMs surgical removal gives better results than AVMs natural history studied over a 20 years period. Ten AVMs observed in deep coma died. Two surgical deaths are only observed out of 73 AVMs surgical removals. Out of 44 lobar AVMs totally removed, 37 show good results and seven disabilities. Out of 19 deep AVMs, 13 were totally removed and six partially. Such deep AVMs, especially AVMs of the corpus callosum or of lateral and third ventricles choroid plexus give excellent surgical results. The authors conclude that surgical removal is the safer treatment for the majority of AVMs (Acta neurol. belg., 1985, 85, 65-81).
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PMID:[Initial clinical signs and results of surgical removal of cerebral arteriovenous malformations]. 400 30

The clinical picture and investigation of 26 patients (16 males and 10 females) with diagnosis of transient global amnesia (TGA) are reported. Age ranged from 51 to 78 years at the time of TGA, which occurred mor often between 60 and 70 year-old people. Three patients presented more than one episode (3, 4 and 5). Precipitating factors were identified in 8 cases (emotional stress in 7 and physical exercise in 1). Risk factors for cerebrovascular disease were found in 13 cases, mainly hypertension (9 cases) and diabetes (3 cases). EEG was normal in 20 cases and disclosed diffuse delta waves in 2, temporal delta waves in 1 and temporal theta waves in another patient. CAT scan showed no abnormalities in 3 cases and ischemia in the vertebro-basilar system in another 2. Brain angiography was normal in 1 case and showed abnormalities in the vertebro-basilar system arteries in 3. During the follow-up period, which ranged from 1 to 84 months, no neurologic deterioration was seen. The role of risk factors for vascular diseases, epilepsy and migraine in the development of TGA is discussed.
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PMID:[Transient global amnesia: study of 26 cases]. 401 36

In a group of 75 patients under the age of 45 years with stroke, ischaemic cerebral infarction was diagnosed in 60 patients and primary intracerebral haemorrhage in 15. Trauma was found to be the commonest identifiable predisposing factor to cerebral infarction, being present in 13 cases (22%). Migraine was the second most commonly identified predisposing factor while atheroma and hypertension were infrequent. Such a high frequency of preceding trauma has not previously been described, perhaps because it is not generally appreciated that the delay between the traumatic event and subsequent stroke may be considerable. The diagnostic management of young stroke patients is considered with particular reference to the indications for specialized cardiac and neuroradiological investigations.
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PMID:The causes of stroke in the young. 403 55

Autonomic dysreflexia, a syndrome sometimes occurring in spinal cord injured (SCI) individuals, may be life-threatening. It involves, in varying degrees, hypertension, diaphoresis, headache, bradycardia, anxiety, and flushing and is believed due to unrestricted sympathetic activity below the level of the lesion in individuals with injuries above T4-6. The most frequent causes of the syndrome are urinary infections, rectal impaction, bladder distention, and decubitus ulcers. To our knowledge, medication has seldom been described as causal agent. We report here on an autonomic dysreflexic syndrome following use of an isometheptene combination (Midrin), to treat migraine. The individual involved is a C4-quadriplegic man with a long history of migraines. He was given a standard initial adult dose of the medication. Over a one-hour period, he was initially relieved of the headache, but then noted a new more severe headache, diaphoresis, and flushing. His vital signs showed progressive BP elevation to 210/130 and a relative bradycardia. Treatment over the next three hours was limited to elevation of the head of the bed and observation, during which his vital signs returned to baseline and he became asymptomatic. This experience reinforces the belief that sympathomimetic drugs in general, and isometheptene in particular, should be used in caution in patients with high-level SCI.
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PMID:Autonomic dysreflexia due to medication: misadventure in the use of an isometheptene combination to treat migraine. 403 34

Caution must be used in the elderly in making the diagnosis of complicated migraine, since transient ischemic attacks (TIAs), other cerebrovascular dysfunction, or structural lesions also can produce prolonged neurologic deficits with headache. Although hypertensive headache itself has no specific diagnostic features, patients who do complain of headache with episodes of hypertension usually localize the pain to the occipital region. This headache is most pronounced on awakening in the morning, usually diminishing 2 to 3 hours after arising.
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PMID:Headaches in older patients: Ddx and Tx of vascular and inflammatory pain. 404 37

A total of 594 patients admitted for cerebrovascular disease (CVD) and for peripheral vascular disease (PVD), were examined in a study aimed at clarifying by a simple, inexpensive out-patient method, a) the relationship existing between the different locations of the vascular disease: brain, lower limbs, coronaries; b) the prevalence in the patients studied of risk factors such as hypertension, hyperlipidaemia and diabetes, and of migraine. The results were as follows: a) of the patients admitted for CVD, 44% also presented arteriosclerosis in other locations; this figure was 32% for PVD cases; b) hypertension was found in 38.5% of CVD and 27% of PVD cases; diabetes in 11.5% of CVD and in 18% of PVD cases; hyperlipidaemia in 31% of CVD and 24% of PVD cases; migraine in 11% of CVD and 1% of PVD cases.
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PMID:Validity of out-patient screening in arteriosclerosis to identify multiple lesions. 406 67

490 women who used Stediril (.5 mg norgestrel and .05 mg ethinyl estradiol, combined) for a total of 5600 cycles or 466 woman-years over a 3 year period are presented. They all took the pills primairly for contraception; most were 20-30 years old, and took Stediril 3-6 months. Some other indications were 119 cases of menstrual irregularity, 15 of spaniomenorrhea, 14 of premenstrual syndrome and 3 of acne, all relieved. 46 of 50 cases of menorrhagia, 83 of 89 of dysmenorrhea and 32 of 34 with pelvic pain were relieved. Withdrawal bleeding was usually less than before and tended to diminish with time. There were 46 women with nausea, 3 of whom stopped Stediril. Migraines sometimes a ppeared, sometimes disappeared, but often occurred regularly on the first day between pill cycles. 52 women complained of breast congestion for the first time. Weight rose in 2301, fell in 98 and stayed constant in 134 after 3 months: weight was easily controlled with diet and appetite supressant drugs. No hypertension was observed. There were 19 single cycles of amenorrhea, several cases of persistant amenorrhea and 4 cases of amenorrhea after stopping. 2-3% of cycles were marked by metrorrhagia; 63 women had spotting, 8 had significant metrorrhagia; 7 had metrorrhagia followed by withdrawal bleeding in that cycle. 1 woman had a thromboembolism of the left leg after 2 pill cycles during which she gained 3 kg. There was 1 pregnancy due to irregular pill use.
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PMID:[Clinical study of an estro-progestative association in low doses. Experience of 3 years (490 patients-5600 cycles)]. 426 90

This review summarizes 169 cerebral vascular accidents in women taking oral contraceptives: 94 arterial (including 13 of the authors' cases), 20 venous, 37 neuroophthalmologic (5 of the authors'), and 18 undetermined diagnoses. The arterial accidents involved the carotid in 56, the vertebrobasilar in 27. Few were fatal; most were considered thromboses; none were due to hemorrhage; few could have been due to emboli or dissecting aneurisms. Aggravation or appearance of migraine was noted in 34 and transient focal cerebral ischemia in 28 cases before arterial accident. No definite time span was obvious, but many occurred 1-6 months or over 2 years after starting pills. Venous accidents were usually fatal, often extended thromboses of the superior longitudinal sinus. Clinically there was severe headache (85%), vomiting, fever without rapid pulse, alteration of consciousness, papillary edema, focal cerebral signs. Ophthalmologic accidents included retinal, arterial, and venous occlusion; paralysis of oculomotor nerve; optic neuritis; and pseudo-tumor-cerebri. The authors recommended caution with oral contraceptives in case of cerebral vascular episodes, migraine, visual disturbances, chorea, hyperlipidemia, and hypertension.
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PMID:[Cerebrovacular accidents and oral contraceptives]. 443 14

The present status of oral contraceptive steroids and the IUD, the 2 most effective and increasingly popular contraceptive methods (used by 41.6% of all U.S. married couples practicing contraception in 1970), is presented. Oral steroid contraceptives with varying quantity and activity of estrogen (ethinyl estradiol or mestranol) and progestogen (norethindrone, norethynodrel, ethynodiol diacetate, or norgestrel), are of 3 types: combination, sequential, and minidose progestogen alone. The most effective contraceptive available is the combined oral pill with a pregnancy rate of less than .2 % per 100 women after 1 year. Contraceptive action is exerted primarily through inhibition of ovulation and secondarily by alterations in cervical mucus, endometrial glands, the ovary, and in the oviduct and uterine muscle. In comparison, sequential oral contraceptives are less effective with greater side effects, and should only be used in women with amenorrhea. Effects of oral contraceptives other than contraception include those on the (1) the primary targets of the female reproductive system, (2) on other endocrine oragans and (3) on the remainder of the body. In the first group, changes may include transitory stromal fibrosis in the ovary, enlarged fibromyomata, intermenstrual bleeding or amenorrhea, increased amount of cervical mucus, polypoid hyperplasia of the endocervical glands, breast tenderness, and changes in lactation. Changes in the second category which may occur affect the adrenal glands, hypothalamus, the thyroid (increased thyroid-binding globulin), and pancreas (alterations in glucose metabolism). Effects on the rest of the body may include increase in serum lipids and changed atherogenic index, abnormalities in liver function, thromboembolism (incidence in oral contraceptive users 4.4 times that in non-users), melasma, alterations in the central nervous system with increased incidence of cerebral vascular accidents, hypertension, and increased body weight. Absolute contraindications to oral contraceptive therapy include cancer of the breast and uterus, pregnancy, active liver disease, hyperlipidemia, and history of gestational diabetes, thromboembolic phenomena or coronary artery disease. Relative contraindications include depression, migraine, myomata of the uterus, hypertension, epilipsy, oligomenorrhea and amenorrhea. Reliable epidemiologic data on IUDs from the Cooperative Statistical Program indicated first year pregnancy rate of 2.5%. Problems with the IUD include: 1) pregnancy with device in situ, which is associated with a higher incidence of spontaneous abortion; 2) ectopic pregnancy, which is prevented at a rate of only 90% compared with intrauterine pregnancies prevented in 97-98%; and 3) expulsions (20% of which are unnoticed), the expulsion rate being higher with decreasing age and parity, higher in the first than second year of use, and higher with smaller than larger devices. A major problem is discontinuation for medical reasons (15% rate in the first year), mainly bleeding and pain. Perforation, another serious complication, occurs initially at time of insertion with an incidence of 1 per 2500 insertions for the loop. IUDs were found to produce a sterile inflammatory tissue reaction, which is postulated as the primary causative factor for their contraceptive effect in humans.
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PMID:Current status of contraceptive steroids and the intrauterine device. 459 80

Several British and U.S. retrospective studies on thromboembolism among users of oral contraceptives prompted the Dunlop Committee to recommend that pills with over 50 mcg mestranol or ethinyl estradiol be avoided to reduce mortality risks by 50%. It is noted that the incidence of idiopathic cases of thromboembolism seems to be increasing, and cigarette smoking may be a cause. Possible etiologic factors, such as lesions in the endothelium of the blood vessels, clotting factors, blood lipids, hypertension, all due to estrogen intake, are discussed. A thromboembolism is sometimes predictable in individuals if there is migraine, visual disturbance, or certain predispositions seen in pregnancy such as toxemia or hypertension. The risks should be weighed against those of other methods of contraception, and against those of pregnancy, but not against those of illegal abortion, which is an unrelated social problem. Women with serious medical indications for effective contraception should be considered differently from those who desire family planning only.
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PMID:[What is to be thought of the Dunlop Committee recommendation concerning the anti-ovulation pills?]. 554 11


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