Abstract-Several studies have demonstrated that endothelial dysfunction is present in patients with essential hypertension.However, the presence of endothelial dysfunction in patients with white coat hypertension has not been studied. We evaluated the variation in the diameter of the brachial artery produced by flow-mediated dilation after a mechanical stimulus in patients with recently diagnosed mild to moderate sustained essential hypertension compared with patients with white coat hypertension. A total of 29 patients fulfilled inclusion criteria; 15 healthy volunteers were also included. After 24-hour ambulatory blood pressure monitoring, 15 patients were classified with sustained essential hypertension; 14 patients with white coat hypertension. Vascular ultrasound scans were performed according to the method described by Celermajer et al, with modification for noninvasive determination of endothelial dysfunction. Basal brachial artery diameter did not differ significantly among the 3 groups. Changes in arterial diameter 60 seconds after cuff deflation were higher in the control group compared with both hypertensive groups, but no significant differences were found between the sustained essential hypertension group and the white coat hypertension group. Flow-mediated dilation was similar in white coat hypertensives and sustained essential hypertensives. The presence of endothelial dysfunction in subjects with white coat hypertension suggests that it should not be considered a harmless trait and that white coat hypertension has common features with sustained essential hypertension. The prevalence of WCH has been estimated by several transversal studies between 20% and 40% among the population of mild hypertensives. 3,4 Whether this group of patients has an increased cardiovascular risk similar to that of sustained essential hypertensives (SEHs), or similar to that of normotensive subjects, is an interesting and still unsolved question that could entail therapeutic implications. 5 Only a few studies have been published about the natural history of WCH; some of them have found a higher frequency of progression to SEH compared with that of normotensive subjects. 6,7 Endothelial dysfunction (ED) is considered an early event in the development of atherosclerosis, 8 and several studies have demonstrated that ED is present in patients with essential hypertension. 9 However, the presence of ED in patients with WCH has not been studied. ED was first studied by measuring the increase of the diameter of coronary arteries after intravenous infusion of acetylcholine; the absence of vasodilation in response to acetylcholine was considered a marker of ED. 10 More recent publications studied ED by measuring vasodilation in response to acetylcholine in brachial or femoral arteries with plethysmography. 11 Nowadays, noninvasive methods based on flow-mediated dilation (FMD) after the compression of the arterial wall with a pneumatic tourniquet have been validated for the study of ED, and they are used in most recent works. 12 Th...

The current recommended treatment for cerebral venous sinus thrombosis (CVST) is anticoagulation, and the presence of intracranial hemorrhage (ICH) is not a contraindication. We present a case of ICH associated with CVST in which heparin treatment was associated with rebleeding, and we review current evidence of anticoagulation safety in patients with ICH associated with CVST. A 65-year-old man presented with right hemiparesis and loss of consciousness. Brain computed tomography showed a left frontoparietal hemorrhage. Angiographic studies with magnetic resonance imaging showed the presence of a partial superior saggital sinus thrombosis. With a diagnosis of CVST, intravenous heparin was administered. After 24 hours the patient had a symptomatic increase in ICH size, and 2 days later the patient developed a status epilepticus with new evidence of rebleeding. Anticoagulant treatment was stopped and the patient experienced neurological improvement, with no new episodes of rebleeding. Evidence for the safety of anticoagulants in CVST comes from 2 small trials involving a total of 79 patients, but only 18 had some degree of bleeding in baseline computed tomography. A meta-analysis suggested that in CVST patients who are treated with anticoagulants, the risk of ICH is low, but acknowledged that an impact of up to 9% of new ICH cannot be ruled out. As there is not enough evidence for the safety of anticoagulant therapy in patients with early ICH associated with CVST, the therapeutic decision must be individualized and the rebleeding risk should be weighed in those patients.

A 38-year-old woman with systemic lupus erythematosus (SLE) and an acute neurological event was studied with computed tomography (CT) and magnetic resonance (MR). Marked intracranial calcification mimicking that seen in hypoparathyroid states was found. The clinical significance of this finding is not clear and the mechanism for cerebral calcification remains unknown.

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