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

A 51-year-old man with polycystic kidney disease had a persistent primitive trigeminal artery, cavum septi pellucidi, and an unruptured cerebral aneurysm. He had a history of long-standing hypertension, but not of subarachnoid hemorrhage. Computed tomograms revealed cavum septi pellucidi. Because of the polycystic kidney disease, we performed four-vessel cerebral angiography, which revealed a persistent primitive trigeminal artery and a cerebral aneurysm at the bifurcation of the left internal carotid artery. The neck of the aneurysm was clipped successfully without producing any neurological deficit. The clinical significance of the combination of these multiple anomalies and cerebral aneurysms is discussed.
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PMID:Persistent primitive trigeminal artery, cavum septi pellucidi, and associated cerebral aneurysm in a patient with polycystic kidney disease: case report. 398 21

Most of "so-called" posterior communicating artery aneurysms previously reported, originated from the internal carotid-posterior communicating junction. Aneurysms arising from the posterior communicating artery itself are very rare. The abducens nerve palsy caused by cerebral aneurysm is also very rare. We are reporting a case with the saccular aneurysm arising directly from the distal half of the posterior communicating artery presenting the abducens nerve palsy. This 73-year-old woman who had no treatment with hypertension for several years was admitted for sudden onset of severe headache, vomitting and unconsciousness on March 1, 1984. She opened her eyes when addressed and had disorientation, urinary incontinence, right-hemiparesis and left-abducens nerve palsy. A 4-vessel angiography revealed the saccular aneurysm originating directly from the distal half of the posterior communicating artery. The patient underwent left-frontotemporal craniotomy on the 27th day after subarachnoid hemorrhage under Hunt & Kosnic Grade 3. The aneurysm originated directly from the distal half of the posterior communicating artery and directed inferior-posterior-laterally below the oculomotor nerve. The neck was successfully clipped. Immediate post-operative course was uneventful until the 7th day after surgery. On the 8th day she had hypertensive intraventricular hemorrhage and expired. The autopsy could not be obtained. The saccular "true" posterior communicating artery aneurysm with isolated unilateral abducens nerve palsy as seen in our case has not been reported. Considering the operative findings, we thought the aneurysmal dome contacted directly with the abducens nerve.
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PMID:["True" posterior communicating artery aneurysm presenting the abducens nerve palsy]. 408 54

Two cases of cerebral aneurysm combined with polycystic kidneys (PCKs) were presented. Case 1, a 24-year-old hypertensive male, was referred to our clinic owing to sudden onset of severe headache at August 20, 1982. Neurological findings on admission were stuporous, right vitreous hemorrhage (so-called Terson's syndrome), and hypertension. CT scans showed subarachnoid hemorrhage, and right MCA bifurcation aneurysm with marked vasospasms by cerebral angiography was revealed. Intentional delayed operation with V-P shunt was performed. He discharged with mild left upper limb paresis, and visual impairment on the right. Bilateral PCKs were confirmed by postoperative DIP and CT scan. Case 2, a 51-year-old female, who suddenly complained of severe headache, was referred to our department 3 days after subarachnoid hemorrhage. One year previously, she had been pointed out PCKs. Neurological findings on admission at February 29, 1980, were drowsy, left third cranial nerve palsy, and hypertension. Cerebral angiography showed multiple aneurysms (bilateral IC-PC & A-com). Neck clipping (1-IC-PC & A-com) and coating (r-IC-PC) were performed at the next day of admission, and V-P shunt operation was followed about 8 weeks after first operation. About 2 weeks after discharge, she suddenly became loss of consciousness and expired. Autopsy revealed intracerebral hemorrhage in left basal ganglia and thalamus. Both kidneys were PCKs of Potter type 3 and cysts of the liver were also noted. In young hypertensive patients with cerebral aneurysms, it should be in mind whether PCKs may be combined or not, and cerebral angiography in PCKs were reasonable to find out harbored cerebral aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Two cases of cerebral aneurysms combined with polycystic kidneys]. 652 33

An account is given of a personal prospective series of 815 patients with the syndrome of spontaneous subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm. It concerns all aneurysm patients at risk, both surgical and nonsurgical cases, referred to the author during two main periods: 606 patients were treated during the earlier period of 15 years, and 209 in the subsequent 7 years. The early mortality rate was determined at 3 months, and all survivors in the first period were followed for a mean of 9 years. Only operation survivors were observed during the second period, for 3 years on average. Patients alive at 3 months were studied in detail with respect to disabilities, work capacity, and later mortality. Of the 815 patients, 613, or 75%, were operated on. Comment is made on the influence of certain factors on early mortality. These include age, hypertension, condition of the patient at admission, and number of hemorrhages. From the results of this series, it is suggested that the preferable time to operate is between the 2nd and the 4th day after a single SAH. In this period, the early mortality rate is in the order of 10%. In this subgroup, a high proportion of the patients were in Botterell Grades 1 and 2, with only a few being in Grade 3. Also evident from the results was the protective value of operation against further aneurysm rupture in the 501 patients surviving at 3 months. However, the propensity of a second aneurysm to rupture in patients with multiple aneurysms has resulted recently in a change of operation policy. The early mortality in the whole series and later mortality in patients surviving 3 months is shown in tabular and histogram form. From these, it is clear the majority of later deaths are from causes unrelated to aneurysm rupture.
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PMID:Ruptured cerebral aneurysms: early and late prognosis with surgical treatment. A personal series, 1958-1980. 686 85

The proper treatment of multiple and incidental aneurysms remains controversial because the long-term result of different modes of management is unclear. This report evaluates the long-term outcome (follow-up period averaged 7.7 years) in 182 patients with multiple aneurysms who suffered a subarachnoid hemorrhage (SAH) to document the incidence of late bleeding. Of the 182 patients, 132 were treated by bed rest and 50 by surgery (craniotomy) directed at only the ruptured aneurysm. Seventy of the patients with bed rest were alive after 6 months. Twenty-one of these conservatively treated patients (30%) suffered a late hemorrhage, which is equal to the previously reported average yearly rebleed rate (3%) with a single aneurysm of the anterior circulation. There was no evidence that a previously intact aneurysm had ruptured in SAH patients treated with bed rest, indicating that late hemorrhage was due to rerupture from the original aneurysm. Patients who were hypertensive and who had a large aneurysm had an increased risk of late rehemorrhage. A linear discriminant analysis was developed to predict late rebleeding. The fate of intact aneurysms was evaluated by following patients with multiple aneurysms treated by craniotomy directed only at the ruptured aneurysm. Of the 50 craniotomy patients, 38 were alive after 6 months. In this group, the minimal risk of rupture of an intact aneurysm is approximately 1% per year. The presence of hypertension increased the risk of late hemorrhage. In conclusion, patients with multiple untreated aneurysms managed by bed rest have a late rehemorrhage rate equal to that observed in patients with a single cerebral aneurysm; the data indicate that rupture of intact aneurysms is not insignificant.
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PMID:The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. 688 85

Rupture of a cerebral aneurysm during angiography, with confirmation by computed tomography (CT), is described. A review of 30 additional reported cases demonstrates no unusual profiles, with the exception of the predominance of female patients (71%), and the presence of pre-angiographic arterial hypertension. Experimental and clinical evidence increasingly suggests that intravascular pressures are transiently elevated during cerebral angiography. These changes may be enhanced by increased flow rates of contrast media, smaller diameters of the catheters, and the presence of intracranial arterial spasm, the latter presenting as a very prominent feature in intra-angiographic arterial rupture. However, direct evidence of elevation of the intra-aneurysmal pressure has not been documented, and may have occurred in only a portion of the cases.
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PMID:Cerebral aneurysmal rupture during angiography with confirmation by computed tomography: a review of intra-angiographic aneurysmal rupture. 698 59

Ten patients who received hypotensive anesthesia for surgical correction of a cerebral aneurysm were pretreated for 1 day with propranolol. In the awake state, before start of anesthesia, mean arterial pressure was 91 +/- 3 torr and plasma renin activity 3.0 +/- 0.1 ng/ml/hr. Thirty minutes after the induction of anesthesia mean arterial pressure decreased to 79 +/- 2 torr and plasma renin activity increased to 3.5 +/- 0.1 ng/ml/hr. There was no further significant change in either measurement with surgical stimulation. During sodium nitroprusside-induced hypotension (the dose used was 0.35 +/- 0.02 mg/kg) mean arterial pressure was reduced to 53 +/- 2 torr, and plasma renin activity increased to 8.8 +/- 0.9 ng/ml/hr. Heart rate did not change. Discontinuation of sodium nitroprusside resulted in a gradual reduction of plasma renin activity to the awake level and concurrent gradual increase in mean arterial pressure to its basal anesthetic value. When compared with previous work, these results indicate that propranolol attenuates nitroprusside-induced renin release, reduces the dosage of nitroprusside required to induce hypotension, suppresses reflex tachycardia, and prevents overshoot hypertension on discontinuation of nitroprusside.
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PMID:Propranolol alters renin release during nitroprusside-induced hypotension and prevents hypertension on discontinuation of nitroprusside. 702 Apr 87

The postoperative intracranial pressure (ICP) in 36 patients operated on for cerebral aneurysm following subarachnoid hemorrhage was studied. Not only was the baseline ICP significantly lower in patients whose outcome was assessed as "good" as compared with those patients with a worse outcome at 1 month after surgery, but also the height of the plateau waves and B-waves was significantly less in the patients who did well. The baseline ICP and the height of the B-wave formation were unrelated to the position of the aneurysm. Plateau waves were marginally significantly higher in aneurysms of the anterior communicating artery complex. Neither preoperative hypertension nor the use of antifibrinolytic agents made any difference to postoperative ICP. In patients with cerebral arterial vasospasm found preoperatively on the angiograms, the ICP tended to be lower in the postoperative period than in those without spasm.
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PMID:Postoperative intracranial pressure in patients operated on for cerebral aneurysms following subarachnoid hemorrhage. 724 Nov 81

A 48 year-old man is presented who died of rupture of intracranial aneurysm. Autopsy findings revealed a ruptured anterior communicating artery aneurysm associated with polycystic kidneys and polycystic liver. Epidermiological review is performed using "Annual of the Pathological Autopsy Case in Japan" (Vol. 17-20). In 92854 autopsy cases, there are 243 cases of polycystic kidney, 1542 cases of intracranial aneurysm and 10 cases of association with both of them. Several points come clear from comparing our data with foreign ones, as follows; 1) The frequency of polycystic kidney (0.25%) is almost the same between Japan and foreign country. 2) The frequency of intracranial aneurysm (1.6%) is higher in Japan. 3) The frequency of association with both (0.01%) is lower in Japan. 4) The frequency of intracranial aneurysm appears to be higher in cases suffered from polycystic kidney than in others. We suspected that cerebral aneurysm formation is caused by hypertension due to polycystic kidney, although in many reports, the association of polycystic kidney and cerebral aneurysm is explained to be maldevelopment. The operation of cerebral aneurysm with polycystic kidney is the same as that without polycystic kidney. But the control of hypertension and renal function is necessary during and after operation.
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PMID:[The association of polycystic kidneys with intracranial aneurysms (author's transl)]. 737 Jan 38

The response of cerebral blood flow (CBF) to drug-induced hypotension was measured in 20 patients who underwent craniotomy for clipping of a cerebral aneurysm following subarachnoid hemorrhage. A modified intravenous xenon-133 injection technique was used to monitor CBF. In 15 patients, CBF increased significantly with hypotension, and only one developed a late neurological deficit. In five patients, CBF fell with halothane-induced hypotension, and four developed delayed neurological deficits. Measurement of the intraoperative CBF response to halothane-induced hypotension may reveal those patients at greatest risk of developing late neurological deficits and who require more intensive postoperative monitoring and early use of the induced hypertension technique.
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PMID:Prediction of late ischemic complications after cerebral aneurysm surgery by the intraoperative measurement of cerebral blood flow. 742 Jan 45


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