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

The incidence of hypertension in past history was investigated in 811 cases of cerebral aneurysm. These cases were compiled from 1,000 cases of saccular aneurysm in which direct surgical operations for aneurysm were performed at our clinic during the period from June 1961 to September 1975. Of the 811 cases, 365 (45%) had hypertension in their past history; 185 (42.7%) out of 433 males and 180 (47.6%) out of 378 females. In the 5th decade of age, the incidence was significantly higher in the females than in the males, but no difference by sex was noted in other age groups. In the males from the 3rd to the 7th decade, the number of hypertensives increased significantly with advancing age, whereas in the females a significant difference was observed only between the 4th and 7th decades, the latter including more hypertensives. The incidence of hypertensives in the aneurysm cases was compared with that in the Japanese population reported by Sasaki. This comparison revealed that in both sexes between the 4th and 6th decades, the incidence was significantly higher in the former, whereas no significant difference was noted between the two in the 7th decade. As to the location of aneurysms, only the multiple aneurysms group had a significantly greater number of hypertensives than single aneurysm group. These results agree with previous reports that cerebral aneurysm may occur more frequently in the hypertensives than in the normotensives.
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PMID:The correlation between hypertension in past history and the incidence of cerebral aneurysms. 49 49

This autosomal dominant disorder usually appears in middle life. The most common findings are proteinuria, abdominal pain and palpable kidneys, followed by hematuria, hypertension, pyuria, uremia and calculi. In 15% of patients, death is due to cerebral aneurysm. Family counseling and the detection of "at risk" family members are important elements of management. Statistically, half of the offspring of one affected parent will have the disease.
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PMID:Polycystic kidney disease. 93 Aug 6

A 64-year-old, hypertensive female suddenly experienced severe headache. On admission, the patient had almost clear consciousness but was slightly restless and complained of severe headache and nausea. Neurological examination revealed only neck stiffness. A computed tomographic scan revealed subarachnoid hemorrhage. Angiographically, bilateral internal carotid and vertebral arteries had the "string of beads sign" at their cervical portion, and the left internal carotid artery also had the same sign at its cavernous portion. The left vertebral artery had low-origin posterior inferior cerebellar artery and a berry-shaped aneurysm at its distal trunk. A diagnosis of cervical and intracranial fibromuscular dysplasia (FMD) with a ruptured berry-shaped aneurysm of the distal vertebral trunk was made. The berry-shaped aneurysm was successfully treated with proximal clipping. Angiographically, right renal and axillary arteries also had the "string of beads sign," and the patient's hypertension seemed to be renovascular in etiology. The co-existence of intracranial FMD and cerebral aneurysm of unusual location suggests a possible relationship between the FMD and the development of cerebral aneurysm.
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PMID:[Fibromuscular dysplasia of the cervical arteries associated with a distal vertebral trunk aneurysm. Case report]. 170 73

We present a 33-year-old female who had a ruptured aneurysm at the trifurcation of the right middle cerebral artery accompanied by coarctation of the aorta. The aneurysm was successfully clipped 15 hours after the attack of subarachnoid hemorrhage and approximately 3 months later the coarctation was surgically treated. Many authors reported that the incidence of cerebral aneurysm was higher in the patients with coarctation than the general population. Our review of the literatures, however, revealed that the incidence of cerebral aneurysm was the same in the population with or without coarctation. The incidence of rupture was higher when the aneurysms was accompanied by coarctation. The average age of the patients at the aneurysmal rupture was younger in the patients with coarctation than the patients without coarctation. These findings suggested that the growth and rupture of aneurysm in the patient with coarctation are related to the hypertension and atherosclerosis. Treatment of the patients with intracranial ruptured aneurysm accompanied by coarctation should begin with the clipping of the aneurysm, and then the coarctation surgically repaired. If the aneurysm is unruptured coarctation should be repaired first, and then the aneurysm clipped.
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PMID:[Ruptured cerebral aneurysm associated with coarctation of the aorta]. 207 50

Subarachnoid hemorrhage induces a lot of extracerebral disturbances such as: systemic hypertension, electrocardiographic abnormalities both morphological, rhythmic and subendocardial damages; those events have been interpreted as overactivity of the sympathetic nervous system. In biochemical changes, hyponatremia early recognized was referred during a long time to a syndrome of inappropriate secretion of antidiuretic hormone. Hyponatremia is now referred to a cerebral salt-wasting. Hypovolemia often observed supports the use of volemic expansion in the prevention and treatment of ischemic complications associated with ruptured intracranial aneurysms. The hypothalamus which lies in close anatomical proximity to the circle of Willis may be directly influenced by the rupture of a cerebral aneurysm. So, hypothalamic dysfunction may affect pituitary adrenal function sympathetic and parasympathetic activities. The knowledge of all these disturbances, and their mechanisms supports the current strategies for the management of aneurysmal subarachnoid hemorrhage.
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PMID:[Physiopathology of meningeal hemorrhage caused by aneurysmal rupture: extracerebral aspects]. 228 35

Two cases, in siblings, of renovascular hypertension caused by fibromuscular dysplasia (FMD) of the renal artery associated with cerebral aneurysms are reported. Both of the cases were found to have cerebral aneurysm, as well as multiple stenotic or occluded lesions in arteries such as renal, mesenteric, celiac, and internal carotid arteries. One case died of subarachnoid hemorrhage and the other case was successfully operated on for the aneurysm. This report suggests that FMD should be considered to be a systemic angiopathy including the cerebral artery, as well as the renal artery. Thus, cerebral angiography is recommended to detect the association with cerebral aneurysm, at least, in cases with multiple lesions of FMD. Occurrence of FMD in siblings also indicates that a genetic factor might be involved in the pathogenesis of FMD.
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PMID:Clinical significance of cerebral aneurysm in renovascular hypertension due to fibromuscular dysplasia: two cases in siblings. 271 43

The authors determined the effect of profound induced hypotension (i.e., mean arterial blood pressure less than 50 mmHg) during craniotomy for cerebral aneurysm on cerebral blood flow and cerebral metabolic rate for oxygen before, during, and after (20 min and 40 min after) the hypotensive period. The study was performed on nine adults (mean age, 29.2 yr) who were awake and conscious without peripheral neurologic deficits at the time of surgery. The study was conducted with the dura open with the use of a radial artery cannula, a 7-Fr thermodilution flow-directed pulmonary artery catheter, and an internal jugular vein catheter. The 133xenon intraarterial injection technique was used to determine regional cerebral blood flow (rCBF) in the nonoperated hemisphere. rCBF remained unchanged (from 22.8 +/- 4.1 ml.100 g-1.min-1 to 23.8 +/- 4.6 ml.100 g-1.min-1) during the hypotensive period (MAP from 87.8 +/- 10.4 mmHg to 40.0 +/- 4.4 mmHg; P less than 0.001) despite an increase in cardiac index since cerebral perfusion pressure and cerebrovascular resistance decreased to a similar degree. No gross cerebral metabolic disturbances were observed. A period of decreased cerebrovascular resistance and increased rCBF followed induced hypotension. rCBF increased from 23.8 +/- 4.6 ml.100 g-1.min-1 to 30.0 +/- 5.8 ml.100 g-1.min-1 (P less than 0.001) 20 min after sodium nitroprusside (SNP) was stopped without rebound hypertension. These modifications disappeared 20 min later. Reduction of mean arterial blood pressure to 40 mmHg by SNP was apparently safe for the brain, although the possibility of low perfused regions and local brain and cerebrospinal fluid lactoacidosis, particularly in the retracted hemisphere, cannot be excluded.
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PMID:Cerebral blood flow and cerebral oxygen consumption during nitroprusside-induced hypotension to less than 50 mmHg. 291 60

A case is described of a 54-year-old 55 kg patient who presented for clipping of a middle cerebral aneurysm two years after a successful renal allograft. Immunosuppression was maintained with azathioprine 100 mg daily, cyclosporine 300 mg daily and prednisone 10 mg daily. The patient had chronic hypertension controlled with nifedipine 40 mg daily and furosemide 20 mg daily. The cyclosporine level taken on the morning of surgery was 166 micrograms.L-1. Induction of anaesthesia consisted of fentanyl 350 micrograms, thiopentone 125 mg and pancuronium 5.5 mg. Anaesthesia was maintained with nitrous oxide 70 per cent in oxygen and isoflurane 0.5-1.5 per cent. No additional doses of pancuronium were given during the four hour surgical procedure. At the end of surgery, four twitches were present with train-of-four stimulation, but evidence of residual muscle paralysis was present. Residual neuromuscular blockade was reversed with atropine 1.2 mg and neostigmine 2.5 mg. Residual paralysis was present in the Recovery Room and edrophonium 10 mg was given prior to extubation. Clinical testing demonstrated adequate reversal of neuromuscular blockade. Twenty minutes following extubation, increasing respiratory distress was noted. There was clinical evidence of muscle paralysis. The patient was re-intubated. It is proposed that cyclosporine potentiated the pancuronium blockade producing prolonged neuromuscular relaxation resulting in residual paralysis following surgery. The potential interactions of cyclosporine and muscle relaxants deserve further study.
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PMID:Cyclosporine-pancuronium interaction in a patient with a renal allograft. 328 71

A case of allergic granulomatous angiitis showing various symptoms of the central nervous system is reported. A 29-year-old female was admitted to our hospital because of severe headache and urinary incontinence. Consciousness was drowsy, and right IIIrd cranial nerve palsy was observed. CT scan revealed subarachnoid hemorrhage, hydrocephalus and arachnoid cyst. Since no aneurysm or arteriovenous malformation was detected by angiography, continuous ventricular drainage was performed. Marked hypertension due to renal vascular origin was suggested by means of laboratory data about serum renin etc., so renal as well as cerebral angiography was carried out by Seldinger's method. There revealed aneurysms of the left renal artery and a branch of the left anterior cerebral artery. Then, ventriculo-peritoneal shunt and resection of left frontal aneurysm were done. Microscopic finding of the excised aneurysm was necrotizing angiitis with infiltration of eosinophil. Six days after the operation, CT scan showed asymptomatic subcortical hematoma at the right occipital lobe. The patient was in good condition and had no cerebral or other complication following steroid therapy. The present case was considered as a very rare one because no case with subarachnoid hemorrhage and cerebral aneurysm due to allergic granulomatous angiitis was reported in the previous literature.
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PMID:[Allergic granulomatous angiitis with subarachnoid hemorrhage--a case report]. 339 97

Thirty-four of 87 consecutive patients with subarachnoid hemorrhage from a cerebral aneurysm had a premonitory minor leak. There were 12 men and 22 women, aged 25 to 73 years (mean 44.4 years). Twenty-two had a small and 12 had a large aneurysm located on the internal carotid artery (17 cases), anterior communicating artery (10 cases), middle cerebral artery (five cases), and pericallosal artery (two cases). Fifty-two percent of patients with a minor leak from an internal carotid artery aneurysm had ipsilateral, hemicranial, hemifacial, or periorbital pain. Half of the patients initially saw a physician, but in no case was the correct diagnosis made. Twenty-five patients had a major rupture within 24 hours to 4 weeks after findings suggesting a minor leak, with a mortality rate of 53%. Nine other patients were diagnosed by lumbar puncture or computerized tomography (CT) scanning after initial misdiagnosis and were operated on, without mortality, before a major rupture could occur. The CT scans were negative in 55% of patients with a minor leak, but lumbar puncture, when performed, was always positive. A minor leak prior to major aneurysmal rupture is a common occurrence and, if unrecognized, is associated with a high mortality. Computerized tomography scanning is unreliable in diagnosing this event, and lumbar puncture is the examination of choice once intracranial hypertension has been ruled out.
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PMID:The minor leak preceding subarachnoid hemorrhage. 378 57


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