The Pathogenesis of Hypertensive Encephalopathy: Experimental Data and Their Clinical Relevance with Special Reference to Neurosurgical Patients

ISBN-13: 9783211814901 / Angielski / Miękka / 1978 / 112 str.

Ludwig M. Auer

Opis

This monograph aims to provide a survey of recent research on the pathogenesis of hypertensive encephalopathy. Or, in other words, to relate experimental results directly to a clinical problem. I am convinced that a very important task of experimental medical research is to find applications to the relevant clinical problem as soon as possible, and to avoid distraction by an increasingly over whelming accumulation of new information from all fields of scientific work. This is undoubtedly easier for a clinician than for a scientist who is only concerned with fundamental research; success ful research for clinical medicine thus requires that clinicians and scientific specialists in the theoretical medical branches cooperate with each other. To fulfill this aim the clinician must be able to think in pathophysiological terms to a considerable extent, which will scarcely be possible if he is involved in routine clinical medicine alone. Experimental work thus presents a real challenge to the physician who wishes to solve a medical problem and also possesses scientific curiosity. Besides an answer to his question, he has the opportunity to obtain a real feeling for what he has learned to call "physiologi cal." I hope with my own experimental work to provide a convincing example of how such work may serve as an impressive reminder to the clinician of the possibly grave consequences of underestimating a development in the course of a serious illness, for instance a hyper tensive episode following head injury."

Spis treści

1. Introduction.- 2. Methods.- 2.1. The Cranial Window Technique.- 2.1.1. Introduction and Historical Survey.- 2.1.1.1. Development of Technique.- 2.1.1.2. The Brain Surface.- 2.1.2. Description of the Present Method.- 2.1.2.1. Operative Procedure.- 2.1.2.2. Technical Equipment.- 2.1.3. Performance of Experiments.- 2.1.3.1. CO2-Reactivity Test.- 2.1.3.2. Induction of Acute Hypertension.- 2.2. Macroscopy and Microangiography.- 2.3. Fluorescence Microscopy.- 2.4. Electron Microscopy.- 2.5. Measurement of Intracranial Pressure and Cerebral Venous Pressure.- 2.6. Discussion of Methods.- 2.6.1. The Window Technique.- 2.6.2. The Photometric Measurements.- 2.6.3. Drugs Used for Production of Hypertension.- 3. Results.- 3.1. The Normal Pial Vessels.- 3.2. Pial Arteriolar Diameter Changes During Hypertension.- 3.2.1. Hypertension During Normccapnia and Normal pH.- 3.2.2. Hypertension During Metabolic Acidosis and Hypercapnia.- 3.2.3. Hypertension During Hypocapnia.- 3.2.4. Hypertension During Metabolic Alkalosis.- 3.2.5. Photometric Results.- 3.2.6. The Sausage-String Phenomenon.- 3.2.7. Discussion.- 3.3. Reactions of Pial Veins and Their Possible Significance in the Origin of Extravasations.- 3.4. The Development of Brain Edema.- 3.4.1. Macroscopy.- 3.4.2. Fluorescence Microscopy.- 3.4.3. Electron Microscopy.- 3.4.3.1. Transendothelial Vesicular Transport.- 3.4.3.2. Tight Junctions.- 3.4.3.3. Diffuse Transendothelial Passage.- 3.4.3.4. Changes in Astrocytes and Neurons.- 3.4.3.5. Discussion.- 3.4.4. General Considerations on Edema.- 3.5. Changes in Intracranial and Cerebral Venous Pressure During Acute Hypertension.- 3.5.1. Intracranial Pressure.- 3.5.2. The Venous Volume-Pressure Relationship.- 3.5.3. The Role of Venous Pressure Increase.- 3.6. Cerebral Blood Flow Measurements in Acute Hypertension.- 3.7. General Discussion and Conclusions.- 3.7.1. Discussion.- 3.7.2. Conclusions.- 4. The Clinical Significance of the Experimental Results.- 4.1. The Interdependence of Blood Pressure and Intracranial Pressure.- 4.2. Clinical Occurrence of Acute Hypertensive Episodes.- 4.3. Special Reference to Neurosurgical Patients.- 5. Epilogue.- 6. Acknowledgements.- References.