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Syphilitic aortic aneurysm presenting with the superior vena cava syndrome
Glossopharyngeal neuralgia
Syncope
Syphilitic
aortitis
Kidney
Embolization
Cholesterol
Continued on page A80
Renal cholesterol embolization can occur spontaneously or as a complication of aortic surgery or major vessel angiography in patients with diffuse atherosclerosis. Previous investigators have emphasized the progressive nature of renal insufficiency due to cholesterol embolism, its poor prognostic significance and almost uniformly fatal outcome. Described in this report are five additional cases of renal cholesterol embolization. In three patients, only moderate renal insufficiency developed and kidney function subsequently improved in all. In two patients, the condition progressed to end-stage renal disease; one died with chronic renal failure whereas the other required four months of hemodialysis before kidney function eventually improved. Thus, cholesterol embolization may produce a spectrum of renal functional impairment. Some patients have only a moderate loss of renal function with subsequent improvement; others progress to renal failure. In this latter group, eventual return of the kidney function can occur even after a prolonged period of renal insufficiency.
aneurysm
A 65 year old man with the superior vena cava syndrome was treated for malignancy but died. At autopsy a syphilitic aortic aneurysm was found. This report emphasizes the important, although now uncommon, association between superior vena cava obstruction and aneurysm of the aorta.
Aortic
A new variant of cluster headache termed chronic paroxysmal hemicrania is described. The importance of recognizing this chronic, intractable headache syndrome is emphasized in view of the dramatic response to the drug, indomethacin.
Smith MC, Ghose MK, Henry AR: The clinical spectrum of renal cholesterol embolization. Am J Med 1981; 71: 174-180.
vena cava
Cluster headache
Hochman MS: Chronic paroxysmal hemicrania: a new type of treatable headache. Am J Med 1981; 71: 169-170.
lndomethacin
Chronic paroxysmal hemicrania
Phillips PL. Amberson JB, Libby DM: Syphilitic aortic aneurysm presenting with the superior vena cava syndrome. Am J Med 1981; 71: 171-173.
Superior
A patient with metastatic laryngeal carcinoma had glossopharyngeal neuralgia and syncope due to hypotension and bradycardia. Treatment of bradyarrhythmias with atropine and a cardiac pacemaker failed to prevent hypotension. The administration of carbamazepine failed to prevent pain or syncope in this patient despite previous reports of success. Symptoms did resolve with intracranial section of the glossopharyngeal nerve and the upper two rootlets of the vagus. Plasma cathecholamines were studied during a hypotensive episode. The values obtained demonstrated a suppressed sympathetic adrenergic neural response but an intact adrenomedullary response, suggesting that suppression of adrenergic vasoconstriction contributed to episodes of hypotension. Intravenous atropine produced a transient increase in blood pressure, suggesting that cholinergic vasodilation may have contributed to the hypotension in this patient.
Dykman TR, Montgomery EB Jr., Gerstenberger PD, Zeiger HE, Clutter WE, Cryer PE: Glossopharyngeal neuralgia with syncope secondary to tumor: treatment and pathophysiology. Am J Med 1981; 71: 165-168.
Tumor
Catecholamines
Syncope
Syphilitic
aortitis
Kidney
Embolization
Cholesterol
Continued on page A80
Renal cholesterol embolization can occur spontaneously or as a complication of aortic surgery or major vessel angiography in patients with diffuse atherosclerosis. Previous investigators have emphasized the progressive nature of renal insufficiency due to cholesterol embolism, its poor prognostic significance and almost uniformly fatal outcome. Described in this report are five additional cases of renal cholesterol embolization. In three patients, only moderate renal insufficiency developed and kidney function subsequently improved in all. In two patients, the condition progressed to end-stage renal disease; one died with chronic renal failure whereas the other required four months of hemodialysis before kidney function eventually improved. Thus, cholesterol embolization may produce a spectrum of renal functional impairment. Some patients have only a moderate loss of renal function with subsequent improvement; others progress to renal failure. In this latter group, eventual return of the kidney function can occur even after a prolonged period of renal insufficiency.
aneurysm
A 65 year old man with the superior vena cava syndrome was treated for malignancy but died. At autopsy a syphilitic aortic aneurysm was found. This report emphasizes the important, although now uncommon, association between superior vena cava obstruction and aneurysm of the aorta.
Aortic
A new variant of cluster headache termed chronic paroxysmal hemicrania is described. The importance of recognizing this chronic, intractable headache syndrome is emphasized in view of the dramatic response to the drug, indomethacin.
Smith MC, Ghose MK, Henry AR: The clinical spectrum of renal cholesterol embolization. Am J Med 1981; 71: 174-180.
vena cava
Cluster headache
Hochman MS: Chronic paroxysmal hemicrania: a new type of treatable headache. Am J Med 1981; 71: 169-170.
lndomethacin
Chronic paroxysmal hemicrania
Phillips PL. Amberson JB, Libby DM: Syphilitic aortic aneurysm presenting with the superior vena cava syndrome. Am J Med 1981; 71: 171-173.
Superior
A patient with metastatic laryngeal carcinoma had glossopharyngeal neuralgia and syncope due to hypotension and bradycardia. Treatment of bradyarrhythmias with atropine and a cardiac pacemaker failed to prevent hypotension. The administration of carbamazepine failed to prevent pain or syncope in this patient despite previous reports of success. Symptoms did resolve with intracranial section of the glossopharyngeal nerve and the upper two rootlets of the vagus. Plasma cathecholamines were studied during a hypotensive episode. The values obtained demonstrated a suppressed sympathetic adrenergic neural response but an intact adrenomedullary response, suggesting that suppression of adrenergic vasoconstriction contributed to episodes of hypotension. Intravenous atropine produced a transient increase in blood pressure, suggesting that cholinergic vasodilation may have contributed to the hypotension in this patient.
Dykman TR, Montgomery EB Jr., Gerstenberger PD, Zeiger HE, Clutter WE, Cryer PE: Glossopharyngeal neuralgia with syncope secondary to tumor: treatment and pathophysiology. Am J Med 1981; 71: 165-168.
Tumor
Catecholamines