Aneurysms dissecting

Endo S, Nishijima M, Nomura H, Takaku A, Okada E. A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage report of three autopsied cases and review of the literature. Neurosurgery 1993 33 732-738. 

In most hypertensive emergencies (except for dissecting aneurysm) hydralazine 5-20 mg i.v. may be given over 20 min, when the maximum effect will be seen in 10-80 min it can be repeated according to need and the patient transferred to oral therapy within 1-2 days. 

In these conditions, blood pressure should be reduced over the course of an hour. In patients with a dissecting aneurysm, where the BP may have been completely normal prior to dissection, the target is a BP of 110/70 mmHg. Otherwise even small reductions will usually remove the emergency. 

A theoretically preferable, but often impractical alternative is i.v. infusion of the vasodilator, nitro-prusside (see p. 470). In dissecting aneurysm, vasodilators should not be used unless patients are first p-blocked since any increase in the rate of rise of the pulse stroke is undesirable. Labetalol provides a convenient method of treating all patients within the three circles (except asthmatics), using either oral or parenteral therapy as appropriate. It is not the most effective, however, and should be combined with a long-acting formulation of nifedipine, orally, where further blood pressure reduction is required. 

Mas JL, Henin D, Bousser MG, Chain F, Hauw JJ. Dissecting aneurysm of the vertebral artery and cervical manipulation a case report with autopsy. Neurology 1989 39(4) 512-15. 

Among the non-ischaemic cardiovascular causes of thoracic pain that should be ruled out, some present a benign prognosis as pericarditis, while others, in turn, point to a much serious prognosis, such as an acute aortic syndrome (dissecting aneurysm or other aortic pathologies) and a pulmonary embolism. On the whole, these account for 5-10% of all cases of thoracic pain. 

Table 7.1 Differential diagnosis between pericarditis, early repolarization, ACS and dissecting aneurysm. 

Pain characteristics Visceral pain often with - Pain increase during respiration. It may seem that pain increases with the exercise because the latter increases respiration frequency - Typical irradiation towards the left shoulder - Sometimes recurrent Can coexist with osteo-articular pain or pain of any other origin (see fig. 7.2 and fig. 7.3) - Isquemic pain often with typical irradiation (see text) - During rest or light exercise - Can be present in any part of the thorax, and even any pain above the navel is suspicious Intensive, visceral pain, mainly located inthe back of the thorax. If this occurs, it is always important to rule out a dissecting aneurysm or an Ml of the lateral wall. 

The most characteristic morphologies of ST-segment elevation in IHD and other situations are shown in Figure 4.13. The most important features that allow for differentiation of ACS from acute pericarditis, early repolarisation and dissecting aneurysm are given in Table 7.1. 

Fibrillin is encoded by a gene located in the long arm of chromosome 15. Mutations in the fibrillin gene lead to an autosomal dominant trait known as Marfan s syndrome. The incidence of this disorder is 1 10,000, and 15-30% of cases are caused by new mutations in the fibrillin gene. Consistent with the function of fibrillin in the elastic connective tissues, the clinical manifestations present as disorders of cardiovascular, musculoskeletal, and opthalmic systems. For example, dissecting aneurysm of... 

Atenolol is indicated in arteriosclerotic heart disease with angina pectoris, hypertension, cardiac arrhythmias and myocardial infarction in hypertrophic obstructive cardiomyopathy, dissecting aneurysm of the aorta, pheochro-mocytoma, and in prevention of migraine headaches. 

Not for patients with angina pectoris, myocardial infarction, dissecting aneurysm or pulmonary edema can increase blood sugar will arrest active labor Preferred by many for emergency treatment of aortic dissection 80 to 90% response rate can be followed by same drug taken orally May precipitate angina, myocardial infarction not used for aortic dissection main use is in pregnancy... 

Cooley, D. Burnett, C. "Fungal Infection in a Dissecting Aneurysm of the Thoracic Aorta", Texas Heart Institute Journal, 1993, 20 (1), 51-54. 

Chase TN, Rosman NP, Price DL The cerebral syndromes associated with dissecting aneurysm of the aorta, a clinico-pathological study. Brain 1968 91 pp. 173-190. 

Aneurysms of the vertebral artery leading to SAH are located at the V4 segment. Dissecting aneurysms are more frequent in this location than non-dis-... 

Albuquerque PC, Fiorella DJ, Han PP, Deshmukh VR, Kim LJ, McDougall CG (2005) Endovascular management of intracranial vertebral artery dissecting aneurysms. Neu-rosurg Focus 18(2) E3... 

Yamaura A, Ono J, Hirai S (2000) Clinical picture of intracranial non-traumatic dissecting aneurysm. Neuropathology 20 85-90... 

Cardiac El-Khatib et al. (H - ) endocarditis Mills and Drew (37 ) serratia marcescens endocarditis Paranthaman and Khan(42 ) acute cardiomyopathy Friedman (15 - ) dissecting aneurysm of coronary artery Hawkins et al. (23= ) intra-arterial drug injection. 

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