Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Altered mental status is a common occurrence in children with acute critical illness. The causes of non-traumatic coma are diverse ranging from neurological to systemic causes. Early appropriate supportive care is essential to avoid preventable secondary insults and optimize the neurological outcome. Evaluation and stabilization of the patient's airway, breathing and circulation (ABCs) must proceed simultaneously with assessments of the depth of coma and the presence of raised intracranial pressure (ICP). Any rapidly correctable cause of coma must be immediately corrected. Most patients with non-traumatic encephalopathies have raised ICP, although papilledema may be absent and the CT scan may be normal if ICP elevation occurs acutely. The most important early treatment for raised ICP is controlled intubation and ventilation followed by osmotherapy. Early control of seizures, including non-convulsive seizures is important. Urgent imaging is indicated in most cases particularly in the presence of afebrile coma, focal signs or papilledema. Following stabilization, isotonic fluids are administered, aiming for euvolemia and euglycaemia. Ventilation should aim for the lower end of eucapnia to avoid causing cerebral ischemia. Surgical options should be explored and, in refractory intracranial hypertension, barbiturates and mild hypothermia may have a role.
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PMID:Emergency and intensive care management of a comatose patient with intracranial hypertension, current concepts. 1673 62

Cerebral venous sinus thrombosis (CVT) can affect all age groups, particularly women of childbearing age. Overall prognosis for survival and functional independence is better than it was believed. Mortality usually ranges from 6-15% and transtentorial herniation is the major cause of death. Approximately 80% of patients are functionally independent in the long term. Altered mental status and cerebral haemorrhage at presentation are the strongest predictors of death and disability. Patients with CVT related to pregnancy and puerperium generally do better than patients with other causes. Septic CVT carries a worse prognosis than aseptic CVT and of the latter, patients with syndrome of isolated intracranial hypertension have a better prognosis than those with focal deficits or encephalopathy. Anticoagulation is believed to improve outcome in CVT although robust data are lacking. Epilepsy, headaches, visual loss, pyramidal deficits and cognitive impairment are some of the long term sequelae. The risk of recurrence of CVT is low, particularly after the first 12 months of the first episode.
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PMID:Prognostic indicators in cerebral venous sinus thrombosis. 1718 90

Tacrolimus-associated posterior reversible encephalopathy syndrome (PRES) is a potential complication of allogeneic stem cell transplant (SCT). Due to the paucity of information on the management of PRES in SCT patients receiving tacrolimus, more information is needed on trends associated with the incidence of PRES and to characterize its management. A retrospective review was conducted of patients receiving tacrolimus for prevention of graft versus host disease (GVHD) after allogeneic SCT who developed PRES from September 2008 to July 2011. Nineteen patients were identified. Altered mental status, seizures, and visual abnormalities were experienced by 78.9%, 52.6%, and 31.5% of the patients, respectively, at time of PRES onset. Compared with baseline, patients with PRES were likely to have an increase in mean arterial pressure (P < 0.0001) and serum creatinine. Elevated tacrolimus levels and hypomagnesemia were not observed with PRES onset. Tacrolimus was managed in three general strategy groups: not held, held then continued, and switched to another agent. Survival was defined as survival to discharge from PRES hospitalization. When tacrolimus was not held, held then continued, or switched to another agent, 40% (2 of 5), 40% (4/10), and 50% (2/4) survived to discharge, respectively. PRES was associated with high blood pressure and adequate blood pressure control should be part of its management. No management strategy pertaining to tacrolimus usage appeared more beneficial over another.
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PMID:Tacrolimus-associated posterior reversible encephalopathy syndrome in hematopoietic allogeneic stem cell transplantation. 2346 Mar 78

Ischaemic stroke is rare in premenopausal women but risk increases with advancing age and doubles in the ten years following the menopause. Up to the age of 75 years men have a 25% higher risk of suffering a stroke compared with women. However, the increased life expectancy of women ultimately results in a higher overall incidence. Twice as many women die from stroke compare with breast cancer. Women with cerebrovascular disease are more likely to present with atypical symptoms than men. Altered mental status (including unresponsiveness, confusion and behavioural change) is the most common nonconventional symptom, and is reported by 23% of women compared with 15% of men. Other nonconventional symptoms reported more commonly by women include face or hemibody pain, lightheadedness and headache. Atrial fibrillation (AF) and hypertension, although less common than in men, are more potent risk factors for stroke in women. Compared with men with AF, women with AF are at increased risk of ischaemic stroke (6.2% versus 4.2% per year). This increased risk persists in anticoagulated patients with a relative risk ratio of 2.0. Pregnancy is a unique risk factor for stroke in women. The risk is highest in the third trimester and peripartum period. Women with hypertension in pregnancy, whether secondary to pre-existing disease, preeclampsia or eclampsia have a six-to nine-fold increased risk of stroke compared with normotensive women. Preeclampsia doubles the risk of stroke in later life. Gestational diabetes is also associated with higher risk of stroke extending beyond childbearing years.
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PMID:Preventing stroke and assessing risk in women. 2913 76