Non-traumatic neurological conditions in medico-legal work
Helen Whitwell, Christopher Milroy, Daniel du Plessis in Forensic Neuropathology, 2021
Chronic hypertension is common and contributes to significant morbidity and mortality in society. It is not only an important contributor to cognitive decline in ageing but also the most significant cause of primary parenchymal brain haemorrhage. Primary hypertensive haemorrhages are typically seen in the central white matter, involving basal ganglia and thalamic nuclei, cerebellum and pons. Within the cerebral hemispheres, they are often extensive with localised tissue disruption, acting as a space-occupying lesion with mass effect, and they often extend into the ventricular system, which can cause ventricular dilatation due to sterile cerebrospinal fluid (CSF) flow obstruction. Histologically cerebral small vessel disease (SVD) is seen in the form of arteriolosclerosis and lipohyalinosis. Arteriolosclerosis is a concentric fibrotic thickening of the media in deep parenchymal vessels, whereas lipohyalinosis is a localised thickening of the media with foamy macrophages and often fibrinoid necrosis.
Atherosclerosis, Arteriolosclerosis and Vasculitis
Jeremy R. Jass in Understanding Pathology, 2020
Arteriolosclerosis is a hyaline (glassy eosinophilic) thickening of the walls of arterioles that is age related but more severe and generalised in hypertensive subjects. Hypertension may be caused by a variety of hormone-secreting tumours, chronic renal diseases and vascular disorders including renal artery stenosis and polyarteritis nodosa. However, the essential cause is unknown in the vast majority of cases, although it is almost certainly polygenic (due to the interaction of several genes and environmental influences). The main complication of hypertension is accelerated atherogenesis leading to the outcomes described above. The major clinical sequelae are hemorrhagic stroke, aortic aneurysm and hypertensive and ischaemic heart disease.
Stroke and Transient Ischemic Attacks of the Brain and Eye
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Arteriolosclerosis (or age-related and vascular risk factor–related small-vessel diseases) is mainly characterized by loss of smooth muscle cells from the tunica media, deposits of fibrohyaline material, narrowing of the lumen, and thickening of the vessel wall. Other pathologic features may include fibrinoid necrosis, lipohyalinosis, microatheroma (distal manifestation of atherosclerosis), microaneurysms (elongated and dilated vessels: saccular, lipohyalinotic, asymmetric fusiform, bleeding globe), and segmental arterial disorganization. In addition to the brain, arteriolosclerosis also affects the kidney and retina. It is strongly associated with aging, hypertension, and diabetes (Table 12.27).
The relationship between calcification inhibitor levels in chronic kidney disease and the development of atherosclerosis
Published in Renal Failure, 2021
Can Sevinc, Gulay Yilmaz, Sedat Ustundag
CKD is a major public health problem worldwide, with a high morbidity-mortality rate and high cost of treatment. In addition to its increasing prevalence, CKD affects public health negatively due to an unacceptably high mortality rate. This elevation in mortality rates is not specific to the advanced stage of kidney disease. Even mild-to-moderate chronic kidney patients are at risk of losing their lives in this process, much more than the chance of progression of kidney disease and the necessity of dialysis treatment [11]. Keith et al., in their study in which they followed 27,998 chronic kidney patients, it was observed that the development of ESRD picture and the need for dialysis in cases with stage 2, 3 and 4 CKD progressed during the 5-year observation period, respectively, by 1.1%, 1.3% and 19.9%; On the other hand, they showed that the loss of life was 19.5%, 24.3% and 45.7% within the same period [12]. It has been determined that the most important cause of increased morbidity-mortality in patients with chronic kidney disease is cardio-cerebrovascular diseases due to athero-arteriolosclerosis [13–15].
Rituximab for the treatment of refractory anti-glomerular basement membrane disease
Published in Renal Failure, 2022
Xue-Fen Yang, Xiao-Yu Jia, Xiao-Juan Yu, Zhao Cui, Ming-Hui Zhao
Six of the 8 patients underwent kidney biopsy at diagnosis (Table 2), and typical linear deposits of IgG along GBM was demonstrated in all of them. All of the patients showed crescent formation with a median percentage of crescents in glomeruli of 85.3% (32 to 95.8%). Four of them (Patients 3, 4, 5 and 6) had diffuse crescents occupying >50% of the glomeruli. Three patients showed IgA deposition in the mesangium area by Immunofluorescence and electron dense deposits in the corresponding area under electron microscopy. All six patients showed tubular atrophy and interstitial fibrosis, interstitial inflammatory cells infiltration. One patient (Patient 1) showed arteriolosclerosis.
Intrarenal resistive index conundrum: systemic atherosclerosis versus renal arteriolosclerosis
Published in Renal Failure, 2019
Gabriel Ștefan, Cosmin Florescu, Alexandru-Anton Sabo, Simona Stancu, Gabriel Mircescu
Hyaline arteriolosclerosis is a common vascular lesion, found in many different situations, including aging, arterial hypertension, diabetes mellitus, focal and segmental glomerulosclerosis. It is generated by the accumulation of serum proteins in the subendothelial space, often extending into the media [16]. Arteriolosclerosis appears to be related to the loss of glomerular autoregulation and, furthermore, to participate in the pathogenesis of the associated glomerular lesions [17].