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

Embolization of cholesterol crystals from ulcerated atheromatous lesions can produce distinct syndromes that mimic more common disease processes. Cholesterol emboli can present as renal failure, hypertension, spells of numbness, abdominal pain, and myocardial infarction, or as a multisystem disease that closely approximates the presentation, clinical course, and even biopsy picture of polymyositis or periarteritis nodosa. A review of this problem with particular attention to the clinical presentations should help in the early diagnosis and treatment of cholesterol emboli and avoid unnecessary and inappropriate therapies.
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PMID:Cholesterol embolism: the great masquerader. 37 Oct 3

The first symptoms of the disease encountered in 30 patients were paresthesia, constant dull headaches and a feeling of numbness of the face or its half. Eventually weakness, atrophia of the masticatory muscles, a drop or absence of the corneal reflexes and cerebral and focal symptoms super vened (the symptoms depended upon the direction of the neurinoma growth). Signs of hypertension were seen in 17 cases. There was also a protein-cell dissociation: 0.5--7% of protein in pleocytosis 6/3--68/3. The craniograms showed a destruction of the ground of the middle cranial cavity in 24 cases, while in 23 cases there was a destruction of the pyramidal apex. Antiographic studies demonstrated a displacement of the carotid siphon medially (18 cases), forward (8 cases) or behind (5 cases). The tumor vascular network was detected in 5 patients. The diagnosis of neurinomas of Gasser's node requires a comprehensive summarization of the clinical and x-ray findings.
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PMID:[Clinical diagnosis of neurinomas of Gasser's ganglion]. 45 90

Impact between the brain and the cristae of the base normally results as a consequence of inertia when an obstacle is hit, followed by contusion, or intra-, sub- or extradural haematoma. The skull itself may be briken (usually at the interpilasters or the weak points of the pilasters) or dented. Denting resulted in the depression of a circular fragments or fragments, with compression of the dura mater or brain; this, in turn, may be contused, lacerated or even crushed. Spinal crash fractures usually involve the lumbar region. Neck fractures are rare. The picture may be one of clinical silence (local pain) or marked neurological involvement. Damage to the cord is expressed in the form of shock, complete flaccid para- or tetraplegia, complete loss of sensation below the lesion, loss of deep and superficial reflexes, urinary retention and rectal incontinence. Treatment is rendered complicated by profuse scalp haemorrhages, respiratory insufficiency requiring orotracheal intubation and assisted respiration, convulsions, which should be handled with care, since ordinary anti-epilepsy products may mask the onset of hypertension and haematoma. Swelling should be reduced with cortisones. Diuretics may be too brusque and lead to intracerebral haematoma. In the case of spinal injuries, particular care should be excercised in shifting the patient and conveying him to hospital. Where high neck lesions are suspected, the possibility of damage to the originating segments of the phrenic nerve must be borne in mind.
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PMID:[Aeromedical problems in cranio-vertebral injuries]. 112 65

A 49-year-old with long-standing hypertension and diabetes developed numbness and sensory loss over the left side of the body consistent with a diagnosis of Pure sensory stroke (PSS). However, CT showed a subcortical infarction in the middle cerebral artery (MCA) territory, which evolved a few hours later towards a large hemispheric infarction associated with severe neurologic worsening. Doppler ultrasounds showed ipsilateral carotid occlusion and contralateral severe stenosis. These findings suggest that PSS may sometimes herald large infarction in the MCA territory in association with carotid occlusion.
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PMID:Pure sensory stroke heralding large hemispheric infarction. 127 92

Disturbances of neurovascular function in the extremities may occur in patients with diabetes mellitus, exposure to toxic substances and chronic exposure to vibrating hand tools, as well as in Raynaud's phenomena. In these conditions symptoms of paraesthesia, finger numbness and blanching occur, so nerve conduction studies, vibration and temperature threshold measurements and neurovascular function tests are used for objective assessment of neurological dysfunction. The aim of the present study was to examine some factors which may confound quantitative neuro-vascular function measurements if used to assess neuropathy in diabetics. All subjects were consenting volunteers without exposure to known neurotoxic chemicals. The 5 groups were (a) healthy non-diabetic subjects not exposed to vibration (n = 10, mean age 52.3 yrs) (b) 2 insulin dependent and 8 non-insulin dependent diabetic subjects with a mean of 6 years treatment (n = 10, mean age 55.7 yrs) (c) maintenance employees exposed to high frequency pneumatic hand tools (n = 10, mean age 52.2 yrs) (d) subjects who were not diabetic or exposed to vibrating tools, but were being treated with the ACE-inhibitor enalapril 20 mg daily for hypertension (n = 5, mean age 54 yrs) (e) subjects who had smoked more than 10 cigarettes daily for at least 15 yrs (n = 10, mean age 51 yrs). Neurovascular tests included axon reflex responses measured by laser Doppler velocimeter evoked on the dorsum of the finger by iontophoresis of acetylcholine 16 mC in a circumferential chamber: cutaneous microvascular dilator responses to endothelial stimulation by iontophoretic application of the muscarinic agonist pilocarpine 16 mC and to direct nitrodilator sodium nitroprusside 16 mC. The skin temperature of the digits was held between 33 degrees and 34 degrees C during testing and dilator responses were measured as flux change by on-line computer analysis using 'Perisoft'. There was a significant reduction (P < 0.05) in the neurovascular responses of both diabetics and vibration--exposed subjects to acetylcholine and, in the case of vibration-exposed subjects, to pilocarpine, but nitroprusside responses were not significantly different. Our findings of reductions in neurovascular responses in diabetics and in subjects exposed to higher frequency vibration is consistent with recent epidemiological findings. Furthermore, subjects treated with an ACE-inhibitor (enalapril) showed significant reduction in acetylcholine-evoked axon reflex responses, while the test group of smokers showed a significant reduction in their dilator response to pilocarpine.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Confounding factors in non-invasive tests of neurovascular function in diabetes mellitus. 134 58

A case of cerebral aspergillosis is reported, the presenting symptom was numbness of right face, which worsened after one year. CT-scan showed two enhanced low-density patches in the anterior and basal parts of right temporal lobe. During operation, an abscess in the deep part of right temporal lobe was revealed. The patient gradually felt amaurosis and oculomotor palsy of right eye. About six months later, she died from intracranial hypertension. Biopsy, as well as autopsy findings suggested fungal infection, and was identified as Aspergillus nidulans, which has probably never been reported in the literature.
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PMID:A case of cerebral aspergillosis caused by Aspergillus nidulans. Clinical, pathologic and mycologic identifications. 211 68

A 27-year-old man was admitted to our hospital for his legs' numbness of subacute onset and discomfort while standing. No specific previous history was found and his family history was non-contributory. On admission, his general status was unremarkable except for arterial hypertension and mild tachycardia. Moderate impairment of superficial sensations and dysesthesia were noted in the distal extremities, tongue, oral cavity, and lips. Deep sensation was moderately impaired in the lower legs. Romberg sign was positive. He had mild weakness in the proximal muscles of the lower extremities. Hyporeflexia was noted in all extremities, but Achilles reflexes were absent. Pathologic reflexes were not noted. He fainted after two minute standing. On laboratory examination, serum IgM, C3, and C4 were mildly elevated. CSF protein level was prominently high without CSF pleocytosis. MCV was mildly decreased, and F wave conduction velocity was prominently decreased in the posterior tibial nerve, SCV was also mildly decreased in the right sural nerve. Needle electromyography showed mild neuropathic changes. Left sural nerve biopsy showed no abnormal finding in the myelinated and unmyelinated fibers. A 60 degree head-up tilting test caused a hypotensive attack, and Valsalva ratio was decreased. However, hand grip test and cold pressor test were normal. The response to noradrenaline infusion test and CVR-R were also normal. Muscle sympathetic activity (MSA) was recorded from the tibial nerve using a tungsten microelectrode (Iwase, et al.). His basic activity was higher and responsiveness was lower than age-matched normal controls. The regression line existed above the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of chronic inflammatory demyelinating polyradiculoneuropathy with orthostatic hypotension]. 227 59

Renal transplantation is an accepted treatment for patients with end stage renal disease from insulin-dependent diabetes mellitus. Acute lumbosacral plexopathy developed following renal transplantation in 4 female patients with insulin-dependent diabetes mellitus between January 1, 1981 and June 30, 1988. In all 4 patients the internal iliac artery was used for revascularization of the renal allograft with ligation of the anterior and posterior divisions. Within 24 hours of surgery they complained of ipsilateral buttock pain, numbness in the leg and weakness below the knee. This complication has not been observed in nondiabetic patients at our institution, nor in diabetic patients when the internal iliac artery was not used. However, lumbosacral plexopathy occurred in 4 of 27 (14.8%) female patients with insulin-dependent diabetes mellitus when the internal iliac artery was used (p less than 0.001). Age, duration of insulin-dependent diabetes mellitus, hypertension, cigarette smoking history and kidney donor were not significant predictors of this complication. This unusual and newly recognized complication appears to result from ischemia of the lumbosacral plexus following ligation of the internal iliac artery in patients with severe small vessel disease.
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PMID:Acute lumbosacral plexopathy in diabetic women after renal transplantation. 229 36

Even in patients with complete loss of sensation and paraplegia after cervical spinal trauma, abdominal operations usually require general or spinal anesthesia due to spasms and increased muscle tone. Both anesthetic types have serious drawbacks under these circumstances, e.g. hyperkalemia induced by relaxation or the impossibility of adequate monitoring of the level of spinal blockade. After an onset time of 1-2 h the intrathecal injection of approx. 100 micrograms baclofen, a spinally acting GABAB-agonist, led to complete and long-lasting suppression of surgically induced spasticity. This could be demonstrated by neurological examination (spasticity scores: Ashworth score, spasm score, clonus score) during 5 neurosurgical operations in 3 patients with paraplegia. Except for slight sedation, the patients had no discomfort during operation. Intrathecal baclofen was also effective against autonomic hyperreflexia, i.e. vegetative dysregulation such as bradycardia or hypertension, provoked by catheterization or bladder surgery.
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PMID:[Intraoperative suppression of spasticity using intrathecal baclofen]. 230 48

A 61-year-old right-handed man with a history of lacunar cerebrovascular disease and hypertension had the sudden onset of right-sided numbness and difficulty speaking. Neurologic evaluation revealed a dense right hemianesthesia that included the face, trunk, arm, and leg. Neuropsychological examination documented a conduction aphasia, which resolved nearly completely several months later. Computed tomographic and magnetic resonance imaging studies showed a lesion in the left hemisphere that involved the posterior insula and disrupted thalamocortical connections but entirely spared the thalamus proper. We suggest that the combination of hemianesthesia and aphasia indicates a white matter lesion subjacent to inferior parietal and posterior temporal cortices.
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PMID:Hemianesthesia and aphasia. An anatomical and behavioral study. 230 79


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