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Cho MJ, Lee MR, Park JG. Aortic aneurysms: current pathogenesis and therapeutic targets. Exp Mol Med 2023; 55:2519-2530. [PMID: 38036736 PMCID: PMC10766996 DOI: 10.1038/s12276-023-01130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 12/02/2023] Open
Abstract
Aortic aneurysm is a chronic disease characterized by localized expansion of the aorta, including the ascending aorta, arch, descending aorta, and abdominal aorta. Although aortic aneurysms are generally asymptomatic, they can threaten human health by sudden death due to aortic rupture. Aortic aneurysms are estimated to lead to 150,000 ~ 200,000 deaths per year worldwide. Currently, there are no effective drugs to prevent the growth or rupture of aortic aneurysms; surgical repair or endovascular repair is the only option for treating this condition. The pathogenic mechanisms and therapeutic targets for aortic aneurysms have been examined over the past decade; however, there are unknown pathogenic mechanisms involved in cellular heterogeneity and plasticity, the complexity of the transforming growth factor-β signaling pathway, inflammation, cell death, intramural neovascularization, and intercellular communication. This review summarizes the latest research findings and current pathogenic mechanisms of aortic aneurysms, which may enhance our understanding of aortic aneurysms.
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Affiliation(s)
- Min Ji Cho
- Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Mi-Ran Lee
- Department of Biomedical Laboratory Science, Jungwon University, 85 Munmu-ro, Goesan-eup, Goesan-gun, Chungbuk, 28024, Republic of Korea
| | - Jong-Gil Park
- Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.
- Department of Bioscience, KRIBB School of Bioscience, Korea University of Science and Technology (UST), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.
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Abstract
Cervical artery dissection is a major cause of ischaemic stroke in young adults. The diagnosis can be challenging as some patients may present with seemingly benign symptoms such as a headache, neck pain or dizziness. However, the neurological sequelae of a transient ischaemic attack, vision loss or ischaemic stroke are potentially devastating. All hospital clinicians must be able to recognise this diagnosis and organise timely and appropriate investigations as antithrombotic treatment reduces the risk of stroke recurrence. This article reviews the literature to provide practical information for clinicians to recognise key risk factors and features of history and examination which should raise suspicion of cervical artery dissection. Diagnosis can now be made using the non-invasive, commonly available modalities of computed tomography angiography or magnetic resonance angiography. Timely treatment with antithrombotic agents is recommended to reduce the rate of an ischaemic stroke.
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Affiliation(s)
- Michael Clark
- Department of Stroke Medicine, University Hospital Crosshouse, Kilmarnock, UK
| | - Sudhakar Unnam
- Department of Radiology, University Hospital Crosshouse, Kilmarnock, UK
| | - Sandip Ghosh
- Department of Stroke Medicine, University Hospital Crosshouse, Kilmarnock, UK
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Monari F, Busani S, Imbrogno MG, Neri I, Girardis M, Ghirardini A, Cavalleri F, Facchinetti F. Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature. J Med Case Rep 2021; 15:530. [PMID: 34670622 PMCID: PMC8527659 DOI: 10.1186/s13256-021-03090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Vertebral artery dissection is an uncommon, but potentially fatal, vascular event. This case aimed to describe the pathogenesis and clinical presentation of vertebral artery dissection in a term pregnant patient. Moreover, we focused on the differential diagnosis, reviewing the available evidence. CASE PRESENTATION A 39-year-old Caucasian woman presented at 38 + 4 weeks of gestation with a short-term history of vertigo, nausea, and vomiting. Symptoms appeared a few days after cervical spine manipulation by an osteopathic specialist. Urgent magnetic resonance imaging of the head was obtained and revealed an ischemic lesion of the right posterolateral portion of the brain bulb. A subsequent computed tomography angiographic scan of the head and neck showed a right vertebral artery dissection. Based on the correlation of the neurological manifestations and imaging findings, a diagnosis of vertebral artery dissection was established. The patient started low-dose acetylsalicylic acid and prophylactic enoxaparin following an urgent cesarean section. CONCLUSION Vertebral artery dissection is a rare but potential cause of neurologic impairments in pregnancy and during the postpartum period. It should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women with a history of migraines, hypertension, or autoimmune disorders in pregnancy are at higher risk, as well as following cervical spine manipulations. Prompt diagnosis and management of vertebral artery dissection are essential to ensure favorable outcomes.
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Affiliation(s)
- Francesca Monari
- Obstetrics and Gynecology Unit, Mother - Infant and Adult Department of Medical and Surgical Sciences, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy.
| | - Stefano Busani
- Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Maria Giovanna Imbrogno
- Obstetrics and Gynecology Unit, Mother - Infant and Adult Department of Medical and Surgical Sciences, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Isabella Neri
- Obstetrics and Gynecology Unit, Mother - Infant and Adult Department of Medical and Surgical Sciences, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Massimo Girardis
- Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Annamaria Ghirardini
- Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Francesca Cavalleri
- Department of Neuroradiology, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Mother - Infant and Adult Department of Medical and Surgical Sciences, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy
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O'Neal MA. Obstetric and Gynecologic Disorders and the Nervous System. Continuum (Minneap Minn) 2020; 26:611-631. [PMID: 32487899 DOI: 10.1212/con.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article highlights the multiple intersections between obstetric/gynecologic issues and neurologic disorders. RECENT FINDINGS Neurologic issues can arise related to contraceptive medications, infertility treatments, pregnancy, and menopause. This article explores these areas in chronologic order, beginning with women's neurologic conditions that overlap their reproductive years and those that may occur during pregnancy and continuing through menopause. For each disorder, the epidemiology, pathophysiology, complications, and best sex-based treatment are described. Recent findings and treatments are highlighted. SUMMARY Obstetric and gynecologic disorders may present with neurologic symptoms, so it is important for neurologists to understand these intersections to deliver the best care for our female patients.
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Abstract
Dissections or ruptures of aortic aneurysms remain a leading cause of death in the developed world, with the majority of deaths being preventable if individuals at risk are identified and properly managed. Genetic variants predispose individuals to these aortic diseases. In the case of thoracic aortic aneurysm and dissections (thoracic aortic disease), genetic data can be used to identify some at-risk individuals and dictate management of the associated vascular disease. For abdominal aortic aneurysms, genetic associations have been identified, which provide insight on the molecular pathogenesis but cannot be used clinically yet to identify individuals at risk for abdominal aortic aneurysms. This compendium will discuss our current understanding of the genetic basis of thoracic aortic disease and abdominal aortic aneurysm disease. Although both diseases share several pathogenic similarities, including proteolytic elastic tissue degeneration and smooth muscle dysfunction, they also have several distinct differences, including population prevalence and modes of inheritance.
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Affiliation(s)
- Amélie Pinard
- From the Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School; University of Texas Health Science Center at Houston (A.P., D.M.M.)
| | - Gregory T Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand (G.T.J.)
| | - Dianna M Milewicz
- From the Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School; University of Texas Health Science Center at Houston (A.P., D.M.M.)
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Tashiro R, Fujimura M, Sakata H, Endo H, Tomata Y, Sato-Maeda M, Niizuma K, Tominaga T. Genetic analysis of ring finger protein 213 (RNF213) c.14576G>A polymorphism in patients with vertebral artery dissection: a comparative study with moyamoya disease. Neurol Res 2019; 41:811-816. [DOI: 10.1080/01616412.2019.1615726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Ryosuke Tashiro
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Hiroyuki Sakata
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Yasutake Tomata
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mika Sato-Maeda
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
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Abstract
Aortic diseases include not only the thoracic but also the abdominal part of the aorta. In the etiology cardiovascular risk factors, such as hypertension, smoking and hyperlipoproteinemia play a major role, but more and more genetic diseases with familiar predisposition are being identified. Even large aneurysms remain asymptomatic as long as other organs in the neighborhood are not damaged and no acute aortic event occurs including aortic dissection, intramural hematoma, penetrating aortic ulcer, and traumatic aortic injury. Standardized algorithms allow precise and rapid diagnosis for initiating medicinal therapy or operative and/or endovascular interventions (thoracic/endovascular aortic repair, TEVAR/EVAR) in this emergency situation. Specialized aortic centers are recommended to form localized regional networks.
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Affiliation(s)
- R Erbel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
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Long B, Koyfman A. Vascular Causes of Syncope: An Emergency Medicine Review. J Emerg Med 2017; 53:322-332. [PMID: 28662832 DOI: 10.1016/j.jemermed.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/05/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Syncope is a common emergency department (ED) complaint, accounting for 2% of visits annually. A wide variety of etiologies can result in syncope, and vascular causes may be deadly. OBJECTIVE This review evaluates vascular causes of syncope and their evaluation and management in the ED. DISCUSSION Syncope is defined by a brief loss of consciousness with loss of postural tone and complete, spontaneous recovery without medical intervention. Causes include cardiac, vasovagal, orthostatic, neurologic, medication-related, and idiopathic, and most cases of syncope will not receive a specific diagnosis pertaining to the cause. Emergency physicians are most concerned with life-threatening causes such as dysrhythmia and obstruction, and electrocardiogram is a primary means of evaluation. However, vascular etiologies can result in patient morbidity and mortality. These conditions include pulmonary embolism, subclavian steal, aortic dissection, cerebrovascular disease, intracerebral hemorrhage, carotid/vertebral dissection, and abdominal aortic aneurysm. A focused history and physical examination can assist emergency physicians in determining the need for further testing and management. CONCLUSIONS Syncope is common and may be the result of a deadly condition. The emergency physician, through history and physical examination, can determine the need for further evaluation and resuscitation of these patients, with consideration of vascular etiologies of syncope.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RSV, Vrints CJM. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2873-926. [PMID: 25173340 DOI: 10.1093/eurheartj/ehu281] [Citation(s) in RCA: 2813] [Impact Index Per Article: 281.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Amin H, Greer DM. Cryptogenic Stroke—The Appropriate Diagnostic Evaluation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 16:280. [DOI: 10.1007/s11936-013-0280-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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[Cerebrovascular diseases]. Internist (Berl) 2009; 50:945-51. [PMID: 19562263 DOI: 10.1007/s00108-009-2367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the majority of the cases cerebrovascular disease is caused by atherosclerosis. Duplexsonography is the diagnostic tool of first choice. Management of cardiovascular risk factors is of paramount importance in secondary prevention of atherosclerotic vascular complications. Patients with a symptomatic internal carotid artery stenosis >70% have a clear indication for revascularization. Asymptomatic patients with >60% stenosis benefit from revascularisation if the perioperative risk for death or stroke is below 3%. The optimal revascularization strategy highly depends on the expertise of the local surgeon or endovascular specialist. In younger patients with cerebrovascular disease rare causes such as dissection, large vessel arteritis, fibromuscular dysplasia or vasospasms have to be considered.
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Abstract
Vascular type of Ehlers-Danlos syndrome (EDS), also known as EDS type IV (NIM#130050) is a life-threatening autosomal dominant inherited disorder of connective tissue, caused by mutations of the COL3A1 gene. Vascular EDS causes severe fragility of connective tissues with arterial and intestinal ruptures and complications of surgical and radiological treatment, and is of particular importance to medical professionals of many specialties: surgeons, internists, radiologists, and obstetricians. An accurate diagnosis may help in the management of visceral complications. In addition, when a family is faced with new information concerning a positive genetic test for vascular EDS, it is crucial that follow-up care for the family include comprehensive genetic counseling. After the genetic diagnosis of a COL3A1 mutation, various medical specialists, including the clinical geneticists must cooperate to perform genetic counseling and to provide a system of long-term follow up for individuals with vascular EDS.
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Affiliation(s)
- Atsushi Watanabe
- Department of Molecular and Medical Genetics, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
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