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)

A 77-year-old man who was suffering from an intracerebral hemorrhage of the left subcortex without hypertension was admitted to our hospital. The only neurological symptom was right arm monoparesis. Brain MRI demonstrated a subarachnoid hemorrhage (SAH) in the left frontal lobe. On the day of admission, conventional cerebral angiography revealed no abnormalities in brain arteries. His symptom was disappeared immediately after admission. He was discharged without neurological deficit on day 25. However, he was rehospitalized in our hospital on the same day because he experienced a right subcortical hemorrhage. The neurological symptoms were consciousness disturbance, aphasia and right hemiparesis. Brain CT disclosed a subcortical hemorrhage in the left temporal lobe. CT stereo-guided drainage was performed. Then, we examined tissue removed from the brain's surface. Histologically, beta-amyloid protein was deposited on the walls of the meningeal and cortical vessels, and it replaced all the layers of those walls. Therefore, a diagnosis of cerebral amyloid angiopathy (CAA) was made. His condition gradually improved, but CT showed an asymptomatic ICH in the right parietal lobe on day 36. On day 47, he had a symptomatic ICH in the left caudate nuclei and right frontal lobe. He died on day 66 because of pneumonia. Intracranial hemorrhages due to CAA have been reported and the majority of the lesions have been lober hemorrhage. To the best of our knowledge, few reports have been published regarding primary SAH caused by CAA. The cause of SAH should be considered as CAA when SAH appears without hypertension or in elderly patients.
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PMID:[A case of primary subarachnoid hemorrhage due to cerebral amyloid angiopathy]. 1749 36

A 75-year-old right-handed woman was admitted to our hospital because of sudden onset of consciousness disturbance. She had taken angiotensin converting enzyme (ACE) inhibitor for hypertension. A neurological examination showed consciousness disturbance, total aphasia, right central facial palsy and right hemiparesis. Diffusion-weighted imaging revealed hyper-intense lesions in the middle cerebral artery territory, particularly in the insular cortex. Magnetic resonance angiography demonstrated occlusion of the left middle cerebral artery. Electrocardiogram monitoring during hospitalization detected an atrial fibrillation. Therefore, we diagnosed her as cardioembolic stroke. She was treated with intravenous alteplase of 0.6 mg/kg. Sixty minutes after alteplase infusion, she developed orolingual angioedema. Immediately she was treated with methylprednisolone intravenously, and the angioedema improved. Orolingual angioedema should be considered as a complication associated with alteplase in a patient who has taking ACE inhibitor.
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PMID:[Orolingual angioedema as complication after rt-PA in stroke patient treated with ACE inhibitor]. 1845 63

We report two cases of reversible brainstem hypertensive encephalopathy (RBHE) with unusual magnetic resonance (MR) findings. Patient 1, an 85-year-old man without a history of hypertension, developed acute severe hypertension and mild consciousness disturbance as the only symptoms. Patient 2, a 46-year-old man with an untreated hypertension, presented with extremely high blood pressure and general fatigue, vertigo, and mild dysarthria as the initial manifestations. In these patients, fluid-attenuated inversion recovery (FLAIR) and T2-weighted MR images revealed diffuse hyperintensities in the brainstem. Diffusion-weighted imaging (DWI) findings were normal, and apparent diffusion coefficient (ADC) values were increased in the brainstem. The supratentorial regions were largely spared, and mildly diffuse hyperintensities were noted in the white matter. There were no accompanying changes in the occipital lobe and cerebellum. The lesions completely resolved after stabilization of blood pressure. The normal DWI findings and high ADC values were consistent with vasogenic edema due to severe hypertension. The characteristics of RBHE are a very high blood pressure, mild clinical and neurologic symptoms, rapidly improved MR findings after initial treatment with the control of hypertension, and a marked clinicoradiologic dissociation.
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PMID:Reversible brainstem hypertensive encephalopathy (RBHE): Clinicoradiologic dissociation. 1867 82

The authors report a rare case of pial single-channel arteriovenous fistula presenting with significant brain edema. A 51-year-old woman was admitted with a 5-day history of headache and nausea, followed by consciousness disturbance. Computed tomography showed cerebellar swelling with obstructive hydrocephalus. Magnetic resonance imaging revealed extensive vasogenic edema in the cerebellum bilaterally. Angiography demonstrated 2 different arteriovenous shunts (AVSs) at peripheral branches of the right anterior inferior cerebellar artery. One was located on the suboccipital surface. It drained through a dilated inferior vermian vein and emptied retrogradely into the contralateral cerebellar veins with marked stagnation. Focal stenosis of the dilated draining vein was present. The other AVS was located on the petrosal surface, which had a slow flow with no angiographic evidence of venous congestion. Given that the latter was believed to be asymptomatic, the former AVS was excised, and histological examination revealed that the lesion consisted of a direct communication of multiple arterial feeding vessels with a single vein, consistent with a diagnosis of pial single-channel arteriovenous fistula. The restriction of venous drainage presumably caused venous hypertension, leading to the brain edema and neurological symptoms.
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PMID:Intracranial pial single-channel arteriovenous fistula presenting with significant brain edema. 1875 83

Apathy is defined as a syndrome of primary loss of motivation not attributable to emotional distress, intellectual impairment or consciousness disturbance. The aim of our study was to investigate the effects of vascular risk factors and silent ischemic brain lesions on apathetic behavior of community-dwelling elderly subjects. Brain MRI and other medical examinations were performed on 222 non-demented community-dwelling elderly subjects (96 men and 126 women, average age 70.1 years). The apathy group was defined as the most apathetic quintile determined by Starkstein's apathy scale. Silent infarction, deep white matter lesions (DWMLs) and periventricular hyperintensities were detected in 12.2, 39.2 and 22.5%, respectively. Linear regression analysis (Pearson) revealed that the scores on the apathy scale correlated slightly but significantly with logarithmically transformed scores of the Modified Stroop Test (r=0.135, P=0.045), but not with the Mini-Mental State Examination. The apathy group tended to have more high blood pressure (141.6/82.6 vs. 136.1/79.6 mm Hg), less prevalent hyperlipidemia (18 vs. 35%) and lower serum albumin. Multivariate analysis (the forward stepwise method of logistic analysis) revealed an independent correlation between the apathy and grade of DWMLs (odds ratio 1.826, 95% confidence interval (CI) 1.129-2.953 per grade) or diastolic blood pressure (DBP) (odds ratio 1.055, 95% CI 1.014-1.098 per mm Hg) after adjusting for possible confounders. The mean apathy scale score in the DBP>or=90 mm Hg group was significantly lower (more apathetic) than that in the DBP<80 group (P=0.011, analysis of covariance). This study showed that hypertension and DWMLs are independently associated with apathy in healthy elderly subjects.
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PMID:Hypertension and white matter lesions are independently associated with apathetic behavior in healthy elderly subjects: the Sefuri brain MRI study. 1942 82

A 21-year-old man developed idiopathic trigeminal neuralgia, and was admitted to our hospital. Although neuralgia was promptly resolved after oral carbamazepine (CBZ) administration, he developed arterial hypertension (from 110/60 mmHg to 170/126 mmHg) followed by consciousness disturbance several days after the initiation of carbamazepine. MRI T2-weighted, FLAIR and ADC images demonstrated transient hyperintense lesions of the bilateral fronto-parieto-occipital subcortical white matter. These lesions showed isointensity on diffusion-weighted images. Since these alterations suggested the presence of vasogenic edema induced by hypertension, we diagnosed him as having reversible posterior leukoencephalopathy syndrome (RPLS) induced by hypertension. Persistent hypertension despite the administration of various anti-hypertension drugs finally improved after oral CBZ therapy was discontinued. Therefore, we considered that hypertension was induced by oral CBZ therapy. This is a rare case in which high blood pressure was caused by CBZ. There is no previous report of RPLS induced by CBZ administration. Further investigation to determine whether CBZ is capable of causing arterial hypertension is warranted.
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PMID:[Reversible posterior leukoencephalopathy syndrome associated with carbamazepine-induced hypertension]. 1946 18

Infundibular dilatations (IDs) are funnel-shaped enlargements of the origin of cerebral arteries. Usually IDs occur at the junction between posterior communicating artery and the internal carotid artery. Progression from an ID of the posterior communicating artery to an aneurysm has previously been described, but it is unclear whether an ID is a pre-aneurysmal state or a normal anatomical variant. In this study, we describe the successful treatment of a small aneurysm originating from a pre-aneurysmal ID. A 63-year-old man suddenly developed severe headache and consciousness disturbance and was admitted to our hospital. CT scans revealed subarachnoid hemorrhage (SAH) mainly in the left sylvian fissure. Three-dimensional computed tomographic angiography (3D-CTA) revealed an ID of the left posterior communicating artery. A small aneurysm of 1.5 mm in diameter was also observerd to extend posterolaterally from the wall of the ID. In addition the left posterior communicating artery was well developed, and the angle between the left internal carotid artery and left posterior communicating artery was large. On the bosis of the CT and 3D-CTA findings, the small aneurysm originating from the ID was considered to be the cause of SAH. On day 18, left pterional craniotomy was performed, and the patient underwent clipping of the small aneurysm. The postoperative course was uneventful. An ID of the posterior communicating artery can develop into an aneurysm and subsequently rupture. The development of an aneurysm from the ID may be influenced by hemodynamic stress and hypertension. Thus patients with the pre-aneurysmal ID should be carefully followed up for a long time.
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PMID:[Rupture of a small aneurysm originating from an infundibular dilatation--case report]. 1988 45

A 48-year-old man presented with consciousness disturbance with vasogenic edema in the occipital lobe on brain CT. The diagnosis of reversible posterior leukoencephalopathy syndrome (RPLS) was made. His hypertension was refractory to treatment, and his neurological disabilities and CT abnormalities, along with renal dysfunction, became worse. Hemodialysis and strict management of blood pressure resolved the neurological findings and the lesions on brain CT. However, one week later, consciousness disturbance and brain CT abnormalities recurred. At that time, hemolytic anemia with fragmented erythrocytes, thrombocytopenia, and renal dysfunction became apparent. We therefore diagnosed thrombotic thrombocytopenic purpura (TTP). Plasma exchange and vincristine administration improved not only the clinical findings of TTP, but also consciousness disturbance and brain CT abnormalities. We concluded that latent TTP had caused RPLS in this patient.
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PMID:Thrombotic thrombocytopenic purpura presenting with reversible posterior leukoencephalopathy syndrome. 2000 43

The salt intake of the Japanese is among the highest in the world, leading to a high prevalence of salt-sensitive hypertension. To prevent this, salt restriction, suppression of the rennin-angiotensin-aldosterone system, and natriuresis are important. Therefore, the use of a combination of an angiotensin II receptor blocker and thiazide diuretics is used for antihypertensive treatment. Some randomized controlled studies suggested that thiazide diuretics are useful not only to lower blood pressure, but also to prevent cardiovascular events and improve prognosis in the elderly, who are prone to being salt-sensitive. We encountered 2 elderly patients referred to our emergency room because of severe hyponatremia and consciousness disturbance, who had been treated with thiazide diuretics for 1 and 2 months, respectively. In both, hypernatriuria despite hyponatremia, slight dehydration, and refractory antidiuretic hormone (ADH) excess were observed, but activation of the rennin-angiotensin-aldosterone system was absent. Thyroid and adrenal functions were unremarkable. Theses phenomena have much in common with the condition called mineralcorticoid-responsive hyponatremia of the elderly (MRHE). Several weeks after discontinuation of diuretics, serum sodium values returned to normal levels, but transtubular potassium concentration gradient (TTKG) values were depleted despite slight hyperkalemia, and relative ADH excess was sustained, which suggested mineralocorticoid dysfunction and distal renal tubulointerstitial injury. Distal tubulointerstitial dysfunction is one of the most important causes of MRHE. On the basis of these 2 cases, we speculated whether distal tubulointerstitial injury may accelerate hyponatremia in the elderly. We need to check not only serum potassium, but also sodium levels, especially in elderly persons with suspected tubulointerstitial injury.
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PMID:[Thiazide diuretics for hypertensive treatment induced severe hyponatremia with consciousness disturbance in two elderly cases]. 2061 53

The aim of this study was to outline the clinicoradiological features of central nervous system (CNS) tuberculoma, and highlight the importance of early treatment. We conducted a retrospective analysis between 1999 and 2008. Clinicoradiological, pathological and follow-up data of 23 patients were reviewed and analysed. The mean age at presentation was 30.3 years (range=17-43 years), and the average disease duration at presentation was six months (range=1-19 months). The tuberculoma location in the cohort was: thoracic region (10 patients); cervical region (six), cervicothoracic region (three); thoracolumbar region (one); and intracranial (six); three patients (13%) had multiple lesions. Nineteen (82.6%) and 15 (65.2%) patients had sensory-motor and bowel/bladder involvement, respectively. Two patients presented with headache and consciousness disturbance, and two patients had a history of pulmonary Koch's disease. Five patients had a history of tuberculous meningoencephalitis, and one patient had a history of enlarged cervical lymph nodes. Twenty-one patients underwent surgery, and two received conservative treatment; all patients received anti-tuberculosis therapy for 18 months. Seventeen of the 21 surgical patients and both conservatively managed patients achieved improved neurological function (with Karnofsky Performance Scale scores of 90-100). Patients presenting at an advanced disease stage had a poorer outcome. CNS tuberculoma is a benign condition with a good prognosis and effective therapy options. Enhanced brain and spine MRI should be performed to ensure the diagnosis is not missed. Early surgical decompression is recommended for intramedullary tuberculoma. Craniotomy is indicated for patients with intracranial hypertension, while more conservative therapy is appropriate for patients who have intracranial tuberculomas without intracranial hypertension.
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PMID:Central nervous system tuberculoma. 2239 88


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