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The pathology of arteriosclerosis is a thickening and diminishing elasticity of the arteries, beginning with the inner coat and gradually spreading and involving all the coats, the larger arteries often developing calcareous deposits or thickened cartilaginous plates an atheroma.
Arteriosclerosis frequently reaches a stage when the blood pressure is low, and with atheroma of the arteries of the arms a true blood pressure is difficult to obtain. Addison's disease, or any other organic lesion of the suprarenals, will lower the pressure, while stimulation of the suprarenals increases the pressure.
This method is suitable to sacculated aneurysm of the limbs, so long as they are circumscribed and free from complications. It has been successfully practised also in aneurysm of the subclavian, carotid, and external iliac arteries. It is not applicable to cases in which there is such a degree of atheroma as would interfere with the successful ligation of the artery.
Syphilis plays an important part in the production of aneurysm, probably by predisposing the patient to arterio-sclerosis and atheroma, and inducing an increase in the vascular tension in the peripheral vessels, from loss of elasticity of the vessel wall and narrowing of the lumen as a result of syphilitic arteritis.
Prostatic hypertrophy. Dr. A. M. Barrett found few changes in nerve cells, except fever changes. One area in left superior frontal gyrus showed superficial gliosis. Yet many of the actions which he felt he must perform were foolish actions. The patient died of pneumococcus septicemia during a lobar pneumonia. There were a few flecks of atheroma in the aorta.
Zillner attributed this circumstance to the small size of the wound, atheroma and degeneration of the aorta and slight retraction of the inner coat, together with a possible plugging of the pericardial opening.
If it occurs later in life it generally is associated with aortic narrowing, and is a part of the general endarteritis and perhaps atheroma of the aorta. Sometimes it is caused by strenuous exertion apparently rupturing the valve. This form of valvular disease frequently ends in sudden death. On the other hand, it is astonishing how active a person may be with this really terrible cardiac defect.
If the patient lives with this arteriosclerosis, a later stage of the arterial disease may occur which has been termed atheroma, with thickening, and possibly calcareous deposits in some parts of the walls of the vessels, while in other parts the coats become thinner and insufficient.
While a real atheroma generally causes a reduction in diastolic blood pressure, or at least but slight increase, he has found in syphilitic cases with arteriosclerosis a high diastolic pressure. If the blood pressure cannot be reduced by ordinary measures, arteriosclerosis is probably present.
There was some question of an acute encephalitic lesion in the tissues lining the posterior half of the third ventricle. Patient was greatly emaciated and anemic from chronic ulcers of ileum. There was also cholelithiasis. There was a mild coronary atheroma and slight mitral valve edge thickening. The delusions expressed were those of great wealth. Patient also thought he was a great poet.
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