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Diagnosis and natural history of hypertensive vascular disease
SELECTED
Diagnosis Perera, G. A.: J. Med. 4:416 (March),
and Natural 1948.
ABSTRACTS
History
of Hypertensive
457
Vascular
Disease.
Am.
The author first discusses the difficulties involved in the definition of hypertension and the The impossibility of making a sharp differentiation between normotension and hypertension. various factors which maintain blood pressure, as well as secondary regulatory mechanisms and the effect of underlying pathologic states unrelated to specific causes of hypertension, are outlined. From an analysis of the author’s series of 2,000 unselected and apparently healthy men between the ages of 20 and 30 years, and from additional studies in the literature, it would appear that about 5 per cent of the adult population is afflicted with this disorder. A clear-cut family history of the disease occurs in 50 to 60 per cent of hypertensive persons. From the records of 2,147 patients with established hypertensive vascular disease, 2.50 subjects were selected in whom adequate data were available from which to draw general conclusions as to the natural history of the disorder. These conclusions form the bulk of the report and emphasize that the first signs usually appear in youth and early adult life and that the average life expectancy is considerably longer than is generally assumed. WOODS.
Hypertensive Scheinker, I. M.: Syndrome. Ann. Int. Med.
Cerebral Swelling, a Characteristic 28:630 (March), 1948.
The author analyzes the pathologic brain disease characterized by a sudden ness, confusion, restlessness, and delirium such as elevation of spinal fluid pressure sions, impairment of vision, and weakness changes found in all cases consisted in a
Clinico-pathologic
and clinical features of twelve cases of hypertensive onset and rapid progression of severe headache, drowsiaccompanied by signs of increased intracranial pressure, and bilateral papilledema, and occasionally by convulof the extremities. The outstanding pathologic brain tremendous degree of cerebral swelling.
The gross findings were characterized by a considerable increase in volume of both hemispheres, flattening of the gyri, and narrowing or obliteration of the sulci; considerable enlargement of the central and subcortical white matter with consequent narrowing and compression of the cortical gray matter; loss of demarcation between white and gray matter; and decrease in size or complete obliteration of both lateral ventricles. In addition, there were disseminated ball hemorrhages in various regions of the brain tissue. Only occasionally were there massive hemorrhages. The pertinent histologic findings may be summarized thus: (1) parenchymatous changes with evidence of swelling of the nerve fibers, myelin sheaths, glia, and particularly of the.obligodendroglia; (2) vascular alterations confined to the small veins and capillaries characterized (a) by congestion and stasis, and (b) by swelling and degeneration of the endothelial cells. These changes In addition, there were arteriolar changes characteristic were predominant in the white matter. of hypertensive arteriopathy. Only occasionally were there seen small focal areas of softening or glial scarring. The diffuse swelling of wide areas of cerebra1 tissue explains why the clinical symptomology occasionally resembles the acute manifestations of brain tumor. Examination of the optic fundi revealed definite signs of papilledema ranging from blurring of the disc margins to pronounced swelling of from 3 to 4 diopters. The retina disclosed various stages of hypertensive retinopathy characterized by constriction and thickening of the retinal arterioles, cotton-wool exudate, recent and old hemorrhages, and venous congestion. In ten of the twelve cases the spinal fluid pressure was high, and in four cases the protein of the spinal fluid was above 130 mg. per cent. Signs and symptoms of impaired renal function were present in all cases. Repeated urinalyses disclosed albumin and casts in the majority of the cases. In only one case were there signs of hematuria. The blood urea nitrogen was in some cases moderately elevated. Only in three cases were there found levels above 100 mg. per cent. At autopsy the kidneys disclosed changes described as arteriolar nephrosclerosis in various stages of development. In but three cases were there changes characteristic of accelerated nephrosclerosis. In one instance the diagnosis of chronic glomerulonephritis was made, and in another instance the diagnosis of chronic pyelonephritis was made. WENDXOS.
Diagnosis Perera, G. A.: J. Med. 4:416 (March),
and Natural 1948.
ABSTRACTS
History
of Hypertensive
457
Vascular
Disease.
Am.
The author first discusses the difficulties involved in the definition of hypertension and the The impossibility of making a sharp differentiation between normotension and hypertension. various factors which maintain blood pressure, as well as secondary regulatory mechanisms and the effect of underlying pathologic states unrelated to specific causes of hypertension, are outlined. From an analysis of the author’s series of 2,000 unselected and apparently healthy men between the ages of 20 and 30 years, and from additional studies in the literature, it would appear that about 5 per cent of the adult population is afflicted with this disorder. A clear-cut family history of the disease occurs in 50 to 60 per cent of hypertensive persons. From the records of 2,147 patients with established hypertensive vascular disease, 2.50 subjects were selected in whom adequate data were available from which to draw general conclusions as to the natural history of the disorder. These conclusions form the bulk of the report and emphasize that the first signs usually appear in youth and early adult life and that the average life expectancy is considerably longer than is generally assumed. WOODS.
Hypertensive Scheinker, I. M.: Syndrome. Ann. Int. Med.
Cerebral Swelling, a Characteristic 28:630 (March), 1948.
The author analyzes the pathologic brain disease characterized by a sudden ness, confusion, restlessness, and delirium such as elevation of spinal fluid pressure sions, impairment of vision, and weakness changes found in all cases consisted in a
Clinico-pathologic
and clinical features of twelve cases of hypertensive onset and rapid progression of severe headache, drowsiaccompanied by signs of increased intracranial pressure, and bilateral papilledema, and occasionally by convulof the extremities. The outstanding pathologic brain tremendous degree of cerebral swelling.
The gross findings were characterized by a considerable increase in volume of both hemispheres, flattening of the gyri, and narrowing or obliteration of the sulci; considerable enlargement of the central and subcortical white matter with consequent narrowing and compression of the cortical gray matter; loss of demarcation between white and gray matter; and decrease in size or complete obliteration of both lateral ventricles. In addition, there were disseminated ball hemorrhages in various regions of the brain tissue. Only occasionally were there massive hemorrhages. The pertinent histologic findings may be summarized thus: (1) parenchymatous changes with evidence of swelling of the nerve fibers, myelin sheaths, glia, and particularly of the.obligodendroglia; (2) vascular alterations confined to the small veins and capillaries characterized (a) by congestion and stasis, and (b) by swelling and degeneration of the endothelial cells. These changes In addition, there were arteriolar changes characteristic were predominant in the white matter. of hypertensive arteriopathy. Only occasionally were there seen small focal areas of softening or glial scarring. The diffuse swelling of wide areas of cerebra1 tissue explains why the clinical symptomology occasionally resembles the acute manifestations of brain tumor. Examination of the optic fundi revealed definite signs of papilledema ranging from blurring of the disc margins to pronounced swelling of from 3 to 4 diopters. The retina disclosed various stages of hypertensive retinopathy characterized by constriction and thickening of the retinal arterioles, cotton-wool exudate, recent and old hemorrhages, and venous congestion. In ten of the twelve cases the spinal fluid pressure was high, and in four cases the protein of the spinal fluid was above 130 mg. per cent. Signs and symptoms of impaired renal function were present in all cases. Repeated urinalyses disclosed albumin and casts in the majority of the cases. In only one case were there signs of hematuria. The blood urea nitrogen was in some cases moderately elevated. Only in three cases were there found levels above 100 mg. per cent. At autopsy the kidneys disclosed changes described as arteriolar nephrosclerosis in various stages of development. In but three cases were there changes characteristic of accelerated nephrosclerosis. In one instance the diagnosis of chronic glomerulonephritis was made, and in another instance the diagnosis of chronic pyelonephritis was made. WENDXOS.