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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe three patients who had painless dissections of the aorta which resulted in neurologic syndromes at the time of presentation. Two patients had acute hemimotor and sensory findings. In one of these cases progression to paraplegia occurred. In a third patient, acute weakness and ischemia of a leg occurred at presentation. We review previously described painless aortic dissections. Such aortic dissections may be suspected in the setting of an acute neurologic event by abnormalities in the examination of the peripheral pulses and the heart and by attention to characteristic chest x-ray changes.
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PMID:Painless dissections of the aorta presenting as acute neurologic syndromes. 373 46

Seven hundred forty-eight carotid endarterectomies were performed on 592 patients with cerebrovascular insufficiency during a 13-year period. Overall operative procedure mortality was 2.7%. In the last 6 years, using a shunt routinely and avoiding operation on acute strokes, mortality was 1.47%. In frank strokes it was 3.7%; in transient ischemia, 0.77%; and zero for chronic ischemia and asymptomatic bruits. Incidence of operation-related deficits among transient ischemia and asymptomatic bruit patients was 0.9% for transient weakness and 2% for permanent deficits. Of 172 long-term deaths, 23 were due to cerebral causes, or 3.9% of the entire series. Among frank stroke survivors, 30.2% are normal and 58.7% improved. In transient ischemia survivors 81% are normal and 15.7% improved. In 65 asymptomatic bruit patients operated upon electively, two had strokes during follow-up, one mild and one severe. Among 37 asymptomatic bruit control patients, 24 or 65% developed symptoms of transient ischemia or frank strokes. Of 118 totally occluded carotid arteries explored, flow was restored in 48 (40.7%) but could not be restored in 70 (59.3%). For cerebral protection during carotid endarterectomy the routine use of a temporary inlying bypass shunt with general anesthesia is advocated for all partial occlusions. Endarterectomy is most useful for transient ischemia and selected patients with mild frank strokes and asymptomatic bruits. Acute profound and rapidly progressing strokes should not be operated upon as an emergency, but allowed to stabilize for several weeks and then be considered for possible operation.
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PMID:Carotid endarterectomy for cerebrovascular insufficiency: long-term results in 592 patients followed up to thirteen years. 395 99

Previous studies have shown that high-altitude hypoxic hypoxia is associated with reduced ventilatory capacity that may be related to skeletal muscle weakness. In the present investigation, ascent to high altitude (4,000 m) was simulated experimentally by exposure of male rats (Sprague-Dawley, 250-350 g), anesthetized with thiopental sodium (25 mg/kg, i.p.), to a breathing gas mixture of 12% oxygen diluted in 88% nitrogen (FiO2 = 0.12). Determinations of oxygen saturation on microsamples (250 ul) of arterial and central venous blood were made spectrophotometrically. Neuromuscular conduction latency was measured following electrostimulation of the sciatic nerve (1-5 V, 0.5 msec duration, 1-40 Hz) and recording of the electromyogram from the gastrocnemius muscle. Experimental hypoxia (FiO2 = 0.12) produced a highly significant increase in conduction latency from a control value (mean +/- SEM) of 3.06 +/- 0.16 msec to 4.02 +/- 0.31 msec (n = 10, P less than 0.001). Conduction latency increased with decreasing arterial oxygen saturation from a control value of 92.9% +/- 0.18% to 83.2% +/- 0.76% (P less than 0.001) in the absence of statistically significant changes in central venous oxygen saturation, central venous pressure, arterial and central venous pH, and heart rate. A significant decrement in the mean arterial blood pressure from a control value of 85 +/- 1.5 mm Hg to 69 +/- 1.5 mm Hg suggests that local ischemia may be a component of this model. These responses were accompanied by marked reduction in uptake of 3,3'-diaminobenzidine (DAB) by gastrocnemius muscle mitochondria, suggesting decreased intracellular activity of cytochrome oxidase. It was concluded that exposure of rodents to hypoxic gas mixtures may provide a suitable model for studying the mechanism of skeletal muscle weakness associated with ascent to high altitude and of other conditions wherein the supply of oxygen to tissues is limited.
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PMID:Relationship between intracellular oxygenation and neuromuscular conduction during hypoxic hypoxia. 609 57

The anatomy and physiology of the nerve root complex in the lumbar spine are reviewed, with special reference to the effects of mechanical deformation of nerve roots in association with intervertebral disc herniation and spinal stenosis. Biomechanical aspects of nerve root deformation induced by compression are discussed. The functional changes induced by compression can be caused by mechanical nerve fiber deformation but also may be a consequence of changes in nerve root microcirculation, leading to ischemia and formation of intraneural edema. Nerve root compression can, by different neurophysiologic mechanisms, induce motor weakness and altered sensibility or pain. Intraneural edema and demyelination seem to be critical factors for the production of pain in association with nerve root compression.
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PMID:Pathoanatomy and pathophysiology of nerve root compression. 637 24

Subdural hematomas (SDH) from ruptured aneurysm (RA) are much less common than intracerebral (ICH) hematomas or subarachnoid (SAH) or intraventricular hemorrhage (IVH). With computerized tomography, preoperative diagnosis is now made more often. The authors have collected 18 such cases from a review of 897 cases of RA admitted to eleven medical centers in 1980 and 1981. Nine (50%) of these patients died prior to discharge from hospital. Four (22%) had surgery and died postoperatively and 9 (50%) were operated upon and survived. Thirteen (72%) of the patients showed anisocoria, decreased consciousness and unilateral weakness prior to surgery. Eight (89%) of the fatalities had shown preoperative herniation as opposed to only 5 (56%) of the survivors. The overall incidence of delayed ischemia due to vasospasm was 11% (2 cases). Those who died had greater midline shift and larger SDH on the admission CT scan. Sixteen (89%) of these patients were female. Thirteen (72%) had ruptured aneurysms on the internal carotid artery. All of these hematomas were unilateral and uniformly hyperdense, and the convexity hematomas were crescentic in shape. Seventeen (94%) had evidence of blood in locations other than the subdural space. If the patient is potentially salvageable and has a midline shift, the SDH should probably be evacuated immediately and the aneurysm clipped at the same operation since the development of a tentorial herniation has such an adverse effect on outcome.
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PMID:Management of acute subdural hematomas from aneurysmal rupture. 646 88

Rhabdomyolysis leading to acute renal failure necessitating hemodialysis is described in three chronic alcoholics. In each case an acute medical or surgical event, but not alcoholic intoxication, was implicated. Renal biopsies demonstrated acute tubular necrosis with intraluminal deposits consisting of Tamm-Horsfall protein and myoglobin. After recovery all three patients were demonstrated to have proximal muscle weakness with similar electromyographic abnormalities but nerve-conduction was impaired in only two. Muscle biopsies showed mixed, but predominantly type II fiber atrophy and reduced muscle phosphorylase levels. In the one patient tested the lactate response to forearm muscle ischemia was abnormal. It is postulated that chronic alcoholics may be predisposed to rhabdomyolysis and acute renal failure following acute medical and surgical stress as well as acute alcohol abuse. The muscle damage in these patients may be due to impaired intra cellular glycogen metabolism.
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PMID:Rhabdomyolysis and acute renal failure in chronic alcoholics with myopathy, unrelated to acute alcohol ingestion. 673 97

Exercise-induced weakness (fatiguing) is described in three patients with cervical compressive radiculopathy. In all three cases, the patients had symptoms only while at work, and in two cases, symptoms occurred in life-threatening situations. All patients had seen several physicians with a functional diagnosis being considered in all cases because of symptoms only at work and the absence of objective findings during examination. Precise history and examination techniques led to the correct diagnosis and treatment after appropriate investigation. The fatiguing weakness in our cases is thought to be a manifestation of early or mild neurologic involvement unmasked by exercise, rather than a manifestation of compression or ischemia.
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PMID:Fatiguing weakness: an initial symptom in cervical compressive radiculopathy. 683 95

Coronary artery aneurysm was demonstrated in 7 patients, whose ages ranged from 38 to 66 years, by selective coronary angiography. Four patients had atypical chest pain probably not caused by cardiac ischemia, 1 patient had aortic stenosis and recurrent bouts of atrial fibrillation, and 2 were evaluated following myocardial infarction and found to have triple vessel atherosclerotic coronary disease. Mitral valve prolapse and varicosities of the coronary venous tree found in one individual suggest that mucoid degeneration which replaces the normal fibrous tissue resulting in weakness of vessel wall may be responsible for the formation of coronary artery aneurysm and varicosities of the coronary venous system. The unsuspected presentation and benign course of these patients are emphasized and the pertinent literature is reviewed.
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PMID:Coronary artery aneurysms. Report of seven cases and review of the pertinent literature. 737 59

Fibrotic contracture of skeletal muscle can follow weeks or months after the severe ischemic insult of compartment syndrome. Commonly known as Volkmann's ischemic contracture, the affected limb often becomes dysfunctional and painful, and may lose sensibility. The pathogenesis of the muscle contracture includes prolonged ischemia, myonecrosis, fibroblastic proliferation, contraction of the cicatrix, and myotendinous adhesion formation. Resultant shortening or overpull of involved muscles leads to stiffness and deformity. Simultaneously, nerve injury from initial ischemia or subsequent soft tissue fibrotic compression leads to muscle paresis or paralysis of the involved compartment and of those muscles more distally innervated. The resultant deformity is thus a combination of varying degrees of contracture and weakness depending on which muscles and nerves are affected. Deformity and functional impairment in the foot and ankle secondary to ischemia are determined by many factors, including: (1) which leg compartment, if any, has been affected and to what degree extrinsic flexor or extensor overpull is exhibited, (2) degree of nerve injury sustained causing weakness or paralysis of extrinsic or intrinsic foot and ankle muscles (3) which foot compartment, if any, has been affected and to what degree intrinsic overpull is exhibited, and (4) degree of sensory nerve injury leading to anesthesia, hypoesthesia, or hyperesthesia of the foot. Therefore, a variety of clinical presentations can be encountered following compartment syndrome of the leg and foot. Treatment is based on an appreciation of the pathoanatomy of the deformity. Nonoperative therapy is aimed at obtaining or preserving joint mobility, increasing strength, and providing corrective bracing and accommodative footwear. Operative management is usually reserved for treatment of residual nerve compression or severe and problematic deformities. Established surgical protocols are performed in a stepwise fashion, to include: (1) release of residual or secondary nerve compression, (2) release of fixed contractures, using infarct excision, myotendinous lengthening, muscle recession, or tenotomy, (3) tendon transfers or arthrodesis to increase function, and (4) ostectomy or amputation for severe, refractory deformities.
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PMID:Volkmann's ischemic contracture of the foot and ankle: evaluation and treatment of established deformity. 755 Sep 46

A 61-year-old man was admitted to our hospital with pain and weakness in both lower legs. Eosinophil count was abnormally high (6800/mm3). Chest X-ray film revealed multiple infiltrates in both lung fields. A specimen obtained by transbronchial lung biopsy demonstrated pulmonary hemorrhage. Vasculitis syndrome was suspected and 1 g per day of methylprednisolone was administered for 3 days. Pulmonary infiltrates quickly disappeared, but 2 weeks later massive intestinal hemorrhage occurred. Emergency ilectomy was done, but the patient died of bleeding from other intestinal lesions. Microscopic examination of the resected ileum revealed mucosal ulceration and necrotizing vasculitis in small arteries. This case is important in that vascular occlusion and ischemia progressed soon after vascular inflammation was relieved by administration of corticosteroid hormone.
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PMID:[Systemic necrotizing vasculitis with pulmonary hemorrhage and gastrointestinal bleeding]. 773 75


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