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)

This 9-year-old girl with rapidly progressive cerebral demyelinating disease presented with hemiplegia and intracranial hypertension. Brain images revealed four lesions with mass effect in the subcortical white matter of both hemispheres. Demyelination was found on pathological studies of these lesions. The patient experienced some recovery with corticosteroid treatment but improved completely with decompressive aspiration of the largest lesion.
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PMID:Decompressive aspiration in myelinoclastic diffuse sclerosis or Schilder disease. Case report. 1250 47

Based on two patients, we discuss the difficulties in diagnosing and managing primary aldosteronism in pregnancy, which derive from changes of the renin-angiotensin-aldosterone axis, from the uncertainty regarding blood pressure control along gestation and postpartum, and from the contraindication to the use of spironolactone. The first case is a 27 years old woman with a long standing refractory hypertension, a hemorrhagic stroke with left brachial hemiplegia and crural hemiparesia, two miscarriages, one stillbirth and one offspring with intrauterine growth retardation. Due to hypokalemia, a plasma aldosterone/renin activity ratio of 91, and a negative genetic screening for glucocorticoid remediable aldosteronism (GRA), a primary hyperaldosteronism with normal adrenals in CT scan was diagnosed, and good blood pressure control was attained with spironolactone. After two and a half years of normotension, a fifth pregnancy, managed with methyldopa evolved with satisfactory blood pressures, plasma potassium, fetal growth, uterine and umbilical arterial resistance indexes, and maternal endothelial function. At 37 1/2 weeks of pregnancy the patient delivered a healthy newborn weighing 2,960 g. Blood pressure rose during the 48 hours of postpartum in the absence of proteinuria and required i.v. hydralazine. The second patient is a 37 years old woman, with known refractory hypertension for 7 years, hypokalemia, plasma aldosterone/renin activity ratio greater than 40, normal adrenals in the CAT scan, and a negative genetic screening for GRA. She had normotensive pregnancies 5 and 3 years prior to the detection of hypertension, with hypertensive crisis in both postpartum periods, retrospectively considered as expressions of primary hyperaldosteronism.
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PMID:[Primary aldosteronism and pregnancy: report of 2 cases]. 1261 Dec 41

After a stroke, recovery that continues beyond 3 or 4 weeks has been attributed to plasticity, a reorganization of the brain in which functions previously performed by the ischemic area are assumed by other ipsilateral or contralateral brain areas. Neuronal plasticity has been variously attributed to redundancy (parallel distributed pathways), changes in synaptic strength, axonal sprouting with formation of new synapses, assumption of function by contralateral homologous cortex, and substitution of uncrossed pathways. Transcranial magnetic stimulation, positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and 128-electrode high-resolution electroencephalography have been successfully applied to demonstrate cortical reorganization after hemiplegia. Recording the motor potential is a promising noninvasive method for the localization of motor control after hemispheric lesions. Most patients with hemiparetic stroke show some improvement, usually during the first 3 to 6 months after the ictus. Improvement and prognosis depend on a number of variables including volume and location of the infarction, age of the patient, and the elimination of risk factors to avoid future episodes (i.e., dietary control of lipids, the elimination of tobacco, and the control of diabetes and hypertension). Currently, emphasis has been placed on fibrinolytic treatment in the first 3 hours to prevent or minimize neurological deficit. Aside from the above listed factors, improvement after stroke may be due to reorganization of the brain, particularly the cerebral cortex, and repair of damaged tissue and recanalization. It is also important to relate such changes to functional improvement and successful rehabilitation.
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PMID:Brain reorganization after stroke. 1468 16

We report a 67-year-old man with rt. hand resting tremor and rigidity after lt. putaminal hemorrhage. He had hypertension and alcoholic liver cirrhosis as past history. When he was 62 years old, he realized rt. hemiplegia suddenly and admitted in Juntendo Urayasu hospital. Brain CT showed intracranial hemorrhage in lt. putamen. He was treated with neurosurgery operation for rejecting hemorrhage. Mild rt. hemiparesis remained but he could live independently. He was medicated sulpiride for depression after cerebrovascular accident. On 63 years old, resting tremor and rigidity appeared on his rt. hand. His doctor stopped sulpiride and treated with L-Dopa/Benserazide and trihexiphenidyl. His parkinsonism was stable with this treatment for four years. His doctor considered that he was Parkinson's disease or drug-induced parkinsonism. On 67 years old, he became akinetic-mutism state suddenly and admitted in the hospital. His consciousness turned alert soon and discharged after two weeks. This episode was considered as epilepsy. After one week from discharge, he was found cardio-pulmonary arrest and confirmed dead in the hospital. Post-mortem examination revealed necrosis in the posterior-lateral part of lt. putamen due to hemorrhage. However, there was no degenerative change of the striatum or the substantia nigra and no Lewy bodies in his brain. Other pathological changes were also not found. His parkinsonism might be caused putaminal pathology due to hemorrhage.
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PMID:[A 67-year-old man with rt. hand resting tremor and rigidity after lt. putaminal hemorrhage]. 1591 60

The aim of this study was to investigate auditory cortex function in the context of auditory stimuli in a patient with auditory agnosia due to bilateral lesions confined to the auditory radiations. A male patient experienced mild left temporal hemiplegia because of right putaminal hemorrhage at the age of 43 years. Thereafter he recovered completely but hypertension persisted. When he was 53 years old, he suffered left putaminal hemorrhage and went into a coma. After recovering from the coma and right hemiplegia he could hear but could not discriminate speech sounds. Brain CT and MRI demonstrated small bilateral lesions confined to the auditory radiations. Magnetoencephalography demonstrated the disappearance of middle latency responses and auditory-evoked potential studies showed a very small Pa peak. In contrast, a positron emission tomography study demonstrated a marked increase in blood flow in the bilateral auditory cortex in response to both click and monosyllable stimuli. It is speculated that the auditory cortex receives functional projections from the cochlea via non-specific pathways in the cerebral hemispheres.
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PMID:Magnetoencephalography and positron emission tomography studies of a patient with auditory agnosia caused by bilateral lesions confined to the auditory radiations. 1630 86

Paragangliomas are unusual tumors that are sometimes familial. We treated a family who exhibited multiple head and neck paragangliomas (HNPGs) and pheochromocytomas. The purpose was to determine the clinical characteristics of paragangliomas with familial history and to define a better standardized proceeding in the management of these tumors. Patients diagnosed with head and neck paragangliomas and identified retrospectively through clinical otolaryngology practices were given a medical and family history questionnaire. We studied a family who exhibited familial paragangliomas. This relationship was examined by reviewing the medical records of family members with verified tumors, carrying out neck computed tomography or magnetic resonance imaging on their relatives to look for tumors that had been unrecognized in the past. All patients underwent a complete head and neck examination. The initial evaluation usually included CT and/or MRI. Computed tomography and magnetic resonance imaging contributed additional information about tumor extension. Angiography was performed in every patient with carotid body tumor, with one undergoing therapeutic embolization to reduce the tumor size. Eleven tumors were identified in four patients with a familial history. Familial disease was initially determined by pedigree analysis. Four patients with a median age of 31 years (range: 25-42) underwent surgery. Median follow-up was 5 years (range 2-14); carotid angiography provided essential mainstays for the definite diagnosis. All patients underwent successful surgical resection of the tumor after the appropriate preoperative preparation. There were no perioperative deaths or hemiplegia. Three patients had bilaterality carotid body paragangliomas. One patient had three paragangliomas, and two patients had bilateral carotid body paragangliomas associated with pheochromocytoma. Clinically functioning tumors and malignant tumors were not identified, and none of the patients died after surgery. During follow-up, none of the patients developed recurrence or metastatic disease. The carotid body paraganglioma (CBPG) and glomus vagale manifested as asymptomatic neck masses. The clinical pheochromocytomas typically present with uncontrolled hypertension. In conclusion, paragangliomas are rare, with multicentricity being more common in patients with a familial history. In patients with familial paragangliomas, high-resolution computed tomography and magnetic resonance imaging are recommended for early screening and contributed additional information about the tumor extension and definitive treatment. Early surgery is recommended to minimize major risks.
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PMID:Familial paraganglioma. 1632 27

The aim of the study was to assess the feasibility and effect of treating atypical endometrial hyperplasia (AEH) with transcervical resection of endometrium (TCRE). Five cases of AEH incapable of hysterectomy for various reasons were treated with TCRE. All patients were followed up for 3-4 years postoperation to evaluate the thickness of endometrium, uterine cavity, and prognosis of the disease. All the patients provided informed consent for TCRE. In all five cases treated with TCRE, case 1 was for senility, hypertension, diabetes mellitus, and obesity; case 4 for senility, obsolete cerebral infarction, and hemiplegia; case 5 for uremia and chronic dysfunction of coagulation after renal transplantation; cases 2 and 3 for rejection of hysterectomy. All cases were followed up for more than 3 years after operation. Four had amenorrhea and one had dropping menses. The thickness of endometrium was no more than 5 mm in all the cases. TCRE is one available microinvasive surgery alternative to hysterectomy for AEH patients contraindicated to hysterectomy.
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PMID:Management of abnormal uterine hemorrhage with atypical endometrial hyperplasia by transcervical resection of endometrium. 1680 56

Cardiac myxoma is a source of emboli to the vascular tree, especially to the central nervous system. Although it is rare, its early recognition is particularly important because of its unique clinical features of subsequently leading to intracerebral or subarachnoid hemorrhage, even brain metastases, and its potential for surgical cure. Missing the diagnosis may lead to devastating results, including stroke, even sudden death. A 40-year-old male with no other conventional vascular risk factors such as hypertension, diabetes or hyperlipidemia presented with right hemiplegia, global aphasia, vomiting, and fever. Infarction over the left middle cerebral artery was disclosed on magnetic resonance imaging study, and echocardiogram showed a huge mass, about 5cm in size, on the mitral valve which was histopathologically proved to be a cardiac myxoma. He also presented with multiple emboli to the kidneys and the left eye. There is uncertainty about the role of anticoagulation. The treatment of choice remains surgical excision of the cardiac myxoma which may lead to normalization of serum interleukin-6 levels and resolution of constitutional symptoms, and the intracranial aneurysms may regress and resolve.
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PMID:Young stroke, cardiac myxoma, and multiple emboli: a case report and literature review. 1699 1

Population based study on stroke morbidity and mortality is lacking in our country. We described the clinical pattern of patients with stroke admitted in Neuromedicine Unit, Chittagong Medical College Hospital, Bangladesh. One hundred and six consecutive patients were included in the study. Clinical diagnosis of stroke, initial assessment, and assessment of outcome of stroke were performed by the neurologists. On admission blood glucose, and creatinine level was estimated, and an electrocardiogram was recorded. Fasting lipid level estimation and CT-scan of brain were performed for patients who could afford the cost. The mean age of the patients was 60.0 +/-13.7 years and the highest occurrence of stroke was found in the age group of 61 - 70 years. The proportions of rural, semiurban and urban patients were 46.2%, 27.4% and 26.4% respectively. A large portion of the patients were found illiterate (47.2%), and only one patient had postgraduate education. The average per capita income was found 1159 +/-762 taka per month. About one-fourth of the patients had diabetes (21.7%). Hypertension, ischemic heart disease and dyslipidemia were found in 59.4%, 18.9% and 11.3% respectively. The cause of hospitalization was altered consciousness (58.5%), right hemiplegia (32.1%), and left hemiplegia (31.1%) either alone or in combination. The mean duration of hospital stay was 5.25 +/-2.19 days. Fifty percent partially and 35% satisfactorily recovered, and 7 (6.6%) patients expired. Patients from lower socioeconomic group were admitted in the hospital. A considerable number of stroke patients had hypertension and diabetes.
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PMID:Characteristics of patients admitted with stroke. 1734 74

Renovascular disease accounts for 8-10% of all cases of paediatric hypertension, whereas, in adults, its incidence is approximately 1%. The Turkish Paediatric Hypertension Group aimed to create the first registry database for childhood renovascular hypertension in Turkey. Twenty of the 28 paediatric nephrology centres in Turkey responded to the survey and reported 45 patients (27 girls, 18 boys) with renovascular hypertension between 1990 and 2005. The age at presentation ranged from 20 days to 17 years. The mean blood pressure at the diagnosis was 169/110 mmHg. Chief complaints of symptomatic patients were headache (38%), seizure (18%), epistaxis (4%), growth retardation (4%), cognitive dysfunction (4%), polyuria (2%), palpitation (2%), and hemiplegia (2%). Renovascular hypertension was found incidentally in 11 children. The diagnosis of renovascular hypertension was established with conventional angiography in 39 patients, MR angiography in three, CT angiography in two, and captopril diethylene triamine penta-acetic acid (DTPA) scintigraphy in one patient. Twenty-one children had bilateral renal artery stenosis and 24 had unilateral renal artery stenosis. Of these, 14 (31%) had fibromuscular dysplasia; 12 (27%) Takayasu's arteritis; six (13%) neurofibromatosis; two (5%) Williams syndrome; one (2%) Kawasaki disease; one (2%) mid-aortic syndrome; one (2%) extrinsic compression to the renal artery, and eight (18%) unspecified bilateral renal artery stenosis. Hypertension was controlled with antihypertensive drugs in 17 patients. Percutaneous transluminal angioplasty (PTRA) or surgery had to be performed in 28 patients: PTRA in 16 patients, PTRA + surgery in one patient and surgery in 11 patients (four nephrectomies). The importance of vasculitic disease, especially Takayasu's arteritis, should not be underestimated in children with renovascular hypertension.
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PMID:Reno-vascular hypertension in childhood: a nationwide survey. 1753 66


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