Paraganglioma Presenting Atypical Initial Symptoms: a Case Report

2021 ◽  
Author(s):  
Shu Eguchi ◽  
Rintaro Ono ◽  
Takeshi Sato ◽  
Keigo Yada ◽  
Naoki Umehara ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Abdominal Mass ◽  
Tumor Resection ◽  
Antihypertensive Agents ◽  
Major Axis ◽  
Left Renal Artery ◽  
Initial Symptoms ◽  
Adrenal Pheochromocytoma ◽  
Unexplained Symptoms ◽  
Reversible Encephalopathy

Abstract Background: Paraganglioma (PGL), an extra-adrenal pheochromocytoma, is a rare tumor, especially in children. Here, we present a case of PGL with atypical initial symptoms.Case presentation: For seven months, an eight-year-old boy complained of polyuria and weight loss, followed by proteinuria and headache for one month prior to admission. He was admitted to our hospital due to an afebrile seizure. His blood pressure remained markedly elevated even after cessation of the convulsion. Magnetic resonance imaging of the brain revealed posterior reversible encephalopathy syndrome. Abdominal computed tomography showed a mass lesion encasing the left renal artery, measuring 41 mm in length along its major axis. The plasma and urine levels of normetanephrine were elevated. Additionally, iodine-123-metaiodobenzylguanidine scintigraphy showed an abnormal uptake in the abdominal mass with no evidence of metastasis. We tentatively diagnosed him with PGL. Substantial alpha- and beta-blocking procedures were performed, followed by a tumor resection and an extended left nephrectomy on day 31 of hospitalization. Pathological findings confirmed the diagnosis of PGL. The postoperative course was uneventful, and his blood pressure normalized without the use of antihypertensive agents. Genetic testing revealed a known SDHB germline mutation. The patient remained asymptomatic for eleven months after surgery without relapse.Conclusion: It remains challenging to diagnose pheochromocytoma/PGL (PPGL) promptly because PPGL can present with a variety of symptoms. Although PPGL is a rare disease, especially in children, it should be considered in differential diagnosis when various unexplained symptoms persist.

scholarly journals Encephalopathy with progression to posterior reversible encephalopathy pattern in a patient with COVID-19: clinical, imaging findings and follow-up

2021 ◽  
Vol 14 (2) ◽  
pp. e241240
Author(s):  
Ali Kerro
Keyword(s):  
Blood Pressure ◽  
Inflammatory Markers ◽  
Elevated Blood ◽  
Imaging Findings ◽  
Clinical Imaging ◽  
Respiratory Dysfunction ◽  
Posterior Reversible Encephalopathy ◽  
Neurological Conditions ◽  
Reversible Encephalopathy

Neurological conditions are being more recognised in patients with COVID-19, with encephalopathy being the most prevalent problem. Posterior reversible encephalopathy is suspected to occur due to elevated blood pressure and overproduction of inflammatory markers, both of which have been reported in the setting of COVID-19 infection. Encephalopathy was the main presentation in this case, without respiratory dysfunction initially, and with imaging findings indicative of posterior reversible encephalopathy syndrome as an aetiology. Follow-up imaging showed resolution of the abnormal results with mental status returning to baseline upon discharge.

scholarly journals A rare case of posterior reversible encephalopathy syndrome in a patient with severe leptospirosis complicated with rhabdomyolysis and acute kidney injury; a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jayawardane Pathiranage Roneesha Lakmali ◽  
Kanapathipillei Thirumavalavan ◽  
Danapala Dissanayake
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Blood Pressure Control ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Vision Loss ◽  
Kidney Injury ◽  
Pressure Control ◽  
Posterior Reversible Encephalopathy ◽  
Peripheral Nerve Involvement ◽  
Reversible Encephalopathy

Abstract Background Leptospirosis is a zoonotic spirochetal disease caused by Leptospira interrogans. The clinical presentation ranges from an asymptomatic state to a fatal multiorgan dysfunction. Neurological manifestations including aseptic meningitis, spinal cord and peripheral nerve involvement, cranial neuropathies and cerebellar syndrome are well recognized with varying frequencies among patients with this disease. Posterior reversible encephalopathy syndrome is a very rare occurrence in leptospirosis and only two cases are reported in the medical literature up to now. We report a case of posterior reversible encephalopathy syndrome in a patient with leptospirosis with rhabdomyolysis and acute kidney injury. Case presentation A 21 year-old male presented with fever and oliguric acute kidney injury with rhabdomyolysis. A diagnosis of leptospirosis was made and he was being managed according to the standard practice together with regular hemodialysis. The clinical condition was improving gradually. On day 8 of the illness, he developed headache and sudden painless complete bilateral vision loss followed by several brief generalized tonic clonic seizure attacks. Examination was significant for a Glasgow Coma Scale of 14/15, blood pressure of 150/90 mmHg and complete bilateral blindness. The findings of magnetic resonance imaging of the brain were compatible with posterior reversible encephalopathy syndrome. He was managed with blood pressure control and antiepileptics with supportive measures and standard treatment for leptospirosis and made a complete recovery. Conclusion Posterior reversible encephalopathy syndrome, though very rare with leptospirosis, should be considered as a differential diagnosis in a patient with new onset visual symptoms and seizures, especially during the immune phase. Optimal supportive care together with careful blood pressure control and seizure management would yield a favourable outcome in this reversible entity.

scholarly journals Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
You-Bin Lee ◽  
Ji Sung Lee ◽  
So-hyeon Hong ◽  
Jung A. Kim ◽  
Eun Roh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Antihypertensive Treatment ◽  
Antihypertensive Agents ◽  
Population Based ◽  
Adverse Outcomes ◽  
Optimal Blood Pressure ◽  
Stage Renal Disease

AbstractThe effect of blood pressure (BP) on the incident cardiovascular events, progression to end-stage renal disease (ESRD) and mortality were evaluated among chronic kidney disease (CKD) patients with and without antihypertensive treatment. This nationwide study used the Korean National Health Insurance Service-Health Screening Cohort data. The hazards of outcomes were analysed according to the systolic BP (SBP) or diastolic BP (DBP) among adults (aged ≥ 40 years) with CKD and without previous cardiovascular disease or ESRD (n = 22,278). The SBP and DBP were ≥ 130 mmHg and ≥ 80 mmHg in 10,809 (48.52%) and 11,583 (51.99%) participants, respectively. During a median 6.2 years, 1271 cardiovascular events, 201 ESRD incidents, and 1061 deaths were noted. Individuals with SBP ≥ 130 mmHg and DBP ≥ 80 mmHg had higher hazards of hypertension-related adverse outcomes compared to the references (SBP 120–129 mmHg and DBP 70–79 mmHg). SBP < 100 mmHg was associated with hazards of all-cause death, and composite of ESRD and all-cause death during follow-up only among the antihypertensive medication users suggesting that the BP should be < 130/80 mmHg and the SBP should not be < 100 mmHg with antihypertensive agents to prevent the adverse outcome risk of insufficient and excessive antihypertensive treatment in CKD patients.

Abstract P489: Effect of Continuous Intake of Hesperidin on Blood Pressure in 2-kidney, 1-clip Renovasucular Hypertensive Rats

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Ayuna Yamaoka ◽  
Yukiko Segawa ◽  
Saki Maruyama ◽  
Natsumi Saito ◽  
Hiroko Hashimoto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mrna Expression ◽  
Control Diet ◽  
Left Renal Artery ◽  
Sham Operation ◽  
Hypertensive Rats ◽  
Fruit Peel ◽  
Arterial Blood ◽  
Significant Difference ◽  
Enos Mrna

Objective: Hesperidin (HES) is a flavonoid which is contained in citrus fruit peel. It has physiological effects on blood vessels such as strengthening capillary vessels. Thus, it is known to be one of the effective ingredients of herbal medicine. Some studies have shown that the intake of HES decreases blood pressure (BP) in spontaneously hypertensive rats. The antihypertensive effect of HES is suggested to be due to vasodilation by nitric oxide (NO). However, its mechanism has not been clarified in detail. In this study, we observed whether HES intake decreases BP in 2-kidney, 1-clip renovasucular hypertensive rats (2K1C) and evaluated endothelial NO synthase (eNOS) mRNA to investigate its role in the mechanism. Methods: Male Sprague-Dawley rats (6 weeks old) were treated with sham operation (SHAM) or clipping the left renal artery (2K1C). After surgery, the rats started receiving continuously a control diet (C) or a diet containing 0.1% (w/w) HES for 6 weeks. The systolic BP (SBP) was measured by a tail-cuff method every week. At the end of the protocol, mean arterial blood pressure (MAP) was measured in each rat under anesthesia. Then, the aortas were removed for extracting mRNA. eNOS mRNA expression was evaluated using real-time RT-PCR. Results: At the end of the protocol, SBP in 2K1C-C was significantly higher than in SHAM-C (170±6 vs 117±6 mmHg, p <0.001). On the other hand, 2K1C-HES was lower in SBP (141±4 mmHg) than 2K1C-C ( p <0.01). There were no significant differences between SHAM-HES (122±7 mmHg) and SHAM-C. MAP at the end of the protocol were similar to in SBP. ANOVA revealed mRNA expression of eNOS was significantly higher in 2K1C than in SHAM ( p <0.05), and showed no significant difference between C and HES, nor a significant interaction. Conclusion: Continuous intake of HES may suppress BP increase in 2K1C. The role of eNOS mRNA expression may not be involved in the mechanism.

Abstract P196: Effect of Combined Oral Intake of Ginger Extract and Rice Vinegar on Blood Pressure with 2-kidney,1-clip Renovascular Hypertensive Rats

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Natsumi Saito ◽  
Yukiko Segawa ◽  
Saki Maruyama ◽  
Ayuna Yamaoka ◽  
Hiroko Hashimoto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mrna Expression ◽  
Tap Water ◽  
Left Renal Artery ◽  
No Production ◽  
Sham Operation ◽  
Ginger Extract ◽  
Angiotensin Type 2 Receptor ◽  
Enos Mrna ◽  
Rice Vinegar

Objective: Ginger is widely used as traditional Asian herbal medicine. Ginger has the same pungent ingredient as chili and vanillyl. We showed that administration of capsaicin to renovascular hypertension (RH) model rats increased endothelial nitric oxide (NO) synthase (eNOS) mRNA expression and NO production, and suppressed blood pressure (BP). Traditionally in Japan, ginger is pickled and eaten. Ginger and vinegar each are supposed to have an effect of suppressing an increase in BP in RH rats. The aim of this study was to investigate the effect. Method: Male Sprague-Dawley rats (6wks) were treated with sham operation (SHAM) as controls or clipping the left renal artery (2K1C) as RH model. After surgery, the rats started receiving a control diet (C) or a diet with 0.08% (w/w) of Ginger Extract (GE) for 6 weeks, and a tap water (W) or a water with 4.5% (v/v) rice vinegar (V). The systolic BP (SBP) was measured by a tail-cuff method every week. At the end of the protocol, the mean arterial BP (MAP) was measured under anesthesia. Then, the aortas were removed for extracting mRNA. mRNA for angiotensin type 2 receptor (AT 2 ) and eNOS was evaluated by real-time RT-PCR. Results: Through the experiment period, SBP was significantly effects in time, model (SHAM vs 2K1C), diet (C vs GE) , timeхanimal ( P <0.001, each) and water (W vs V) ( P <0.05). At the end of the protocol, 2K1C-C+W was higher in SBP than SHAM-C+W (176 ± 6 vs 138 ± 1 mmHg, P <0.05). 2K1C-GE+W showed lower SBP (150 ± 2 mmHg) than -C+W ( P <0.05). SBP was not significantly different in 2K1C-GE+V (149 ± 4mmHg) from in -GE+W. The observations in MAP were similar to those in SBP. AT 2 R mRNA expression showed significant effects in model ( P <0.05) : the mRNA in 2K1C-C+W (0.9 ± 0.2) was significantly greater than in SHAM-C+W (0.4 ± 0.1) ( P <0.05). There were no significant differences among the 2K1Cs: -C+W, -C+V (0.9 ± 0.1), -GE+W (0.8 ± 0.1) and -GE+V (0.9 ± 0.2). eNOS mRNA expression showed significant effects only in diet (CTL vs GE, P <0.05), but not in water and any interactions. Conclusion: Continuous ingestion of GE and V may suppress BP increase in 2K1C, respectively. Simultaneous ingestion of GE and V showed no enhanced effects compared to GE or V solo ingestion in 2K1C. The roles of eNOS and AT 2 R in the mechanism did not become clear in this study.

scholarly journals Blood Pressure Control: Stroke and Stroke Prevention

2005 ◽  
Vol 6 (1_suppl) ◽  
pp. S8-S11
Author(s):  
Hans-Christoph Diener
Keyword(s):  
Blood Pressure ◽  
Stroke Prevention ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Angiotensin Receptor ◽  
Risk Of Death ◽  
Pressure Lowering ◽  
Receptor Blockers

Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention. All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention. Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP) increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences. The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

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